Reporting Format for Regional Chairs and NGDOs (Latin America 08/2008 to 12/2008)

1) Indicate the regularity of VISION 2020 programmes in that country.

a) Sustained VISION 2020 activities (twice a year or more) b) Intermittent activities (at least once a year) c) No activity in the recent past (2 years) d) No information available

Note: During the IAPB meeting in Geneva in July 2007, the Caribbean Council for the Blind (CCB) agreed to furnish IAPB with the relevant information for the region, hence in this report, our office has not included information from the Caribbean basin.

S.

Periodicity Launched

Country

VISION

No

No. Regular

Intermittent

activity 2020

1 Argentina a Y

2 Bolivia a Y

3 Brazil a Y

4 Canada a Y

5 Chile a Y

6 Colombia a Y

7 Costa Rica a Y

8 Cuba a Y 9 Dominican

Republic a Y

10 Ecuador a Y

11 El Salvador a Y

12 Guatemala b Y

13 Honduras a Y

14 Mexico a Y

15 Nicaragua a Y

16 Panama b N

17 Paraguay a Y

18 Peru a Y

19 United States a N

20 Uruguay a b Y

21 Venezuela a Y

2) List partners for each of these countries (blank means no data available to the LA office)

Partners

S. N o. Others

IAPB

(Corporate,

Country

Government member

NGDOs Individuals,

Agency (yes/no)

Institutes

etc.) 1 Argentina LIONS, ORBIS, FOAL, Y

CMB Y 2 Bolivia ULLS DEL MON, Y Y

FOAL, CMB, MIRADA SOLIDARIA, LIONS, Light for the World

3 Brazil CBM, FOAL, Y Y Y LIGHTHOUSE, SEE INTERNATIONAL LIONS 4 Canada N Y Y

5 Chile LIONS, FOAL, CMB Y Y

6 Colombia SEE Y Y Y INTERNATIONAL, LIONS, CMB 7 Costa Rica LIONS, CMB, ORBIS, Y Y

FOAL

8 Cuba LIONS, ORBIS, CBM Y Y

9 Dominican CMB, LIGHTHOUSE, Y Y Republic SEE INTERNATIONAL, CMB, LIONS

10 Ecuador CMB, FOAL, MIRADA Y Y SOLIDARIA, LIONS

11 El CBM Y Salvador

12 Guatemala LIONS, FOAL, N Y LIGHTHOUSE, CBM,

ORBIS

13 Honduras CBM, FOAL, SEE N Y INTERNATIONAL 14 Mexico CMB, HELEN Y Y Y KELLER, FOAL,

LIGHTHOUSE, CCB- SSI 15 Nicaragua CMB, FOAL, SEE Y Y INTERNATIONAL

16 Panama SEE N N INTERNATIONAL,

FOAL 17 Paraguay CBM, ORBIS, LIONS, Y Y Y

FOAL

18 Peru SEE Y Y Y INTERNATIONAL,

CMB, FOAL, ORBIS, LIONS

19 United Y Y Y States

20 Uruguay LIONS, CBM Y Y

21 Venezuela CBM, FOAL, LIONS Y Y

3) What VISION 2020 priorities are active in your region? (Check

all that apply) Cataract Trachoma Onchocerciasis Childhood Blindness Refractive Error & Low Vision Diabetic Retinopathy and Glaucoma Other (Specify Regional priorities)

X

X

X

X

4) Areas of focus to promote VISION 2020 priorities in your region: (check all that apply and rank in order of priority)

� Priority

Disease Control 2 Human Resource Development 1 Infrastructure Development 3 Research 4

5) Please list regular programmes taken up in your region.

Describe the nature of activities under such programmes.

S.

Country Nature of Activity Period

No.

1 Argentina Cataract surgery and ROP programmes in 2008 various provinces. Great advances in LV

activities. Hosted the GA8 and III Iberoamerican VISION 2020 Congress as well as the I Argentine Public Health Ophthalmology meeting in August. The SIBEN Congress on ROP was held in Mar del Plata en September. Very successful ROP programs particularly in the South. The Castelli community in the northern province of El Chaco has finished a RACSS and aims to be declared Cataract Blindness Free

2 Bolivia Cataract surgery programmes. Established PBL Committee in June 2008

3 Brazil Great advances in ROP screening and training, 2008 including wider adoption of national guidelines. Many cataract surgical programmes and Diabetic Retinopathy screening and treatments. In Sao Paulo, many refractive errors programs active. Twenty training centres have begun a pilot programme to include CEH in their curricula, Formed CEH and VISION 2020 committee in the Brazilian Council of Ophthalmology (CBO), Refractive Errors screening in school age children, primarily in Sao Paulo. Twenty facilitators trained in in Brazil.

Two CEH courses have taken place in 2008. Follow up of ROP course in November

4 Canada Strong support to developing countries. 2008 5 Chile Great support from the Government for 2008

Cataract, ROP, Diabetic Retinopathy and

X

X

X

X

Refractive errors. CEH concepts have been officially adopted by the National Society of Ophthalmology as part of the training curricula.. All priority V2020 disease and other are guaranteed by government funding.

6 Colombia

Many active Cataract and ROP programmes. Held CEH Planning course in March with MOH authorities as well as an ROP course in February. CEH Course for government institutions took place in the third trimester 2008

7 Costa Rica Cataract, ROP and Refractive Errors. Hosted the Central American ROP Congress 2008

8 Cuba Strong cataract surgical programmes, advances 2008

in Diabetic Retinopathy, LV and ROP. Helps training Human resources for various Caribbean nations

9 Dominican Large cataract surgical programmes, ROP 2008 Republic council has begun activities, Low Vision clinics, Government will start paying for cataract

surgeries as of June 2007. Will commence RAAB study in September. ROP Course held in July. Priority Country report completed. RAAB study conducted in the third quarter

10 Ecuador Long standing with wide coverage ROP 2008 programmes, Many surgical campaigns sponsored by the prevention of blindness society. $US 200,000 allocated to cataract surgeries in 2008 by MoH. CBM Low Vision Advisors meeting. 02/08 11 El Salvador Cataract surgical programmes and outreach as 2008

well as spectacle dispensing. Formed VISION 2020 Committee in June

12 Guatemala Many cataract surgical programmes and 2008 refractive errors services, V2020 Committee has reunited and good conversations with the

government established but not much activity developed. Priority country report completed.

13 Honduras Cataract surgical campaigns and programmes, 2008 currently developing the National PBL Plan.

14 Mexico National cataract surgery training centre established helping further develop cataract surgery programmes and campaigns in 14 2008 states of the country

15 Nicaragua A meeting to reignite the VISION 2020 Committee will be held in late July 2008

plan during WSD 2006 celebrations.

16 Panama Have participated with Four articles for the 2008

V2020 LA quarterly bulletin. Initial conversations to form the VISION 2020 Committee started.

17 Paraguay Many surgical campaigns and regular 2008 programmes, CEH curricula in one residency training programme, ROP screening and treatment programmes.

Will hold First South American Ophthalmology residents meeting in October

Held a Fundraising Course in March in conjunction with CBM and the local partner, Fundacion Vision

III CEH Management Program in November

VISION 2020 PBL Plan officially relaunched and financed by the Government in December. Held the First ever Ophthalmology Residents Meeting of South America (EROCS) with PBL concepts taught by Serge Resnikoff, Colin Cook, Miriam Cano, Fernando Barria, Francisco Contreras, Rainald Duerksen and van Lansingh

18 Peru Many surgical campaigns and regular 2008 programmes established. Improvement in ROP screening in Lima, and some major cities, and developed national

Guidelines. A well established outreach program for refractive errors in children and adults is functioning

Priority Country report completed

19 United States Strong support to developing countries. 2008

20 Uruguay CEH classes being held in the residency training program. 2008

A National referral hospital established late last year

21 Venezuela Many ongoing cataract surgical programmes, 2008 including those operating overseas. Two very good ROP programmes.

Note: GA8 and WSD activities have been reported in a separate form earlier this

year.

6) Please provide a summary of the work in the priority areas in your

region, with regard to HRD & Training, Disease Control, and Infrastructure development and appropriate technology.

HRD and Training status

Three CEH courses took place during the second semester of the year, including the one for residencies in Brazil. *Please see annexes*

Active participation of various technical subcommittee members as well as of Dr. Rainald Duerksen and Van Lansingh in the WOC held in Hong Kong in June 2008. Currently Van Lansingh is working with Miriam Cano, Daksha Patel and Rainald Duerksen to develop the CEH curricula and reading list as well as basis Power presentations to be made available via the ICO website. Additionally Van Lansingh has been appointed to the ICO Refractive Errors task force and as a member of the editorial board of the Official Journal of the Argentine Council of Ophthalmology (CAO). Van Lansingh conducted a project visit on behalf of SSI to Belize and represented Mrs. Pat Ferguson in the annual CCB meeting.

During the reporting period, the following article or guidelines were also published: The priority country reports for Peru, Guatemala and the Dominican Republic have been completed and are available on request in Spanish by writing to vlansingh@v2020la.org The Latin-American Guidelines for VISION 2020 Advocacy have been completed and are also available in Spanish or English by writing to vlansingh@v2020la.org The August and December VISION 2020 LA quarterly bulletins are available online in three languages by clicking http://www.v2020la.org/bulletin/esp/docs/boletin_13/index.html The July and December edition of the CEHJ in Spanish are available by clicking www.revistasaludocular.org Limburg, H, Barria-VB, F, Gomez, P, Silva, JCS, Foster, A. Review of recent surveys on blindness and visual impairment in Latin America. First seen on line Br. J. Ophthalmol 2008 Three papers have been accepted in peer reviewed journals, as soon as the details are available they will be provided. Disease Control Appropriate Technologies Others

7) Please summarize activities taken up towards resource mobilization in your region.

ALCON has generously agreed to support the Paraguay CEH Management course and will also support the CEHJ in Spanish starting in 2008 *Also supported by the FHF, ORBIS and CBM

ALLERGAN generously sponsored the printing and distribution of the ROP Latin American Guidelines. OEU Continues to generously support the VISION 2020 LA Regional office.

8) List the Vision Rehabilitation and blindness programmes

active in your region under VISION 2020; please also list programme launches.

Note: Those listed here are the ones sponsored by CBM which were provided as a courtesy by both regional offices as well as some from ORBIS, but do not reflect those sponsored by other International NGOs or local agencies, a comprehensive list has been requested to all the NGOs.

Partner Country Location Belize Council for the Visually Impaired BCVI Belize Belize-City ASEMBIS - Asoc. de Servicios Médicos Para El Bien Social Costa Rica San Jose Patronato Nac. De Ciegos, Inc. Centro De Rehab. para Ciegos Dominican Republic Santo Domingo Centro Cristiano de Servicios Médicos, Hospital Dr.E.Santana Dominican Republic Santo Domingo Comité Evangélico Salvadereno de Ayuda y Desarrollo - CESAD El Salvador San Salvador Programa Nacional de Salud Visual (FUDEM) El Salvador San Salvador

PBL Program AGAPE El Salvador Sonsonate PBL Program El Peten Guatemala San Benito

Ciudad de Blindness Prevention in Western Guatemala Guatemala Guatemala

Grace Childrens Hospital Haiti Port-au-Prince Petit Goave Eye Clinic Haiti Petit Goave

Hopital Universite d'Etat d'Haiti (HUEH) Haiti Port-au-Prince Gebeau - Eye Health Services Jeremie Haiti Jeremie

Club de Leones'La Fraternidad' Clinica de Oftalmologia Honduras San Pedro Sula Centro Cristiano De Servicios Médicos Honduras El Progreso

Clinica Oftalmologica Vida Abundante Honduras Tegucigalpa Hospital 'LA CARLOTA' Clinica de Oftalmología Mexico Montemorelos

Asociación Centro de Rehabilitación para Ciegos - ACREC Mexico Cuernavaca Salud Ocular Ciudad Juarez Mexico Ciudad Juarez

Vision 2000 Mexico Manzanillo

Eye Care Service Oaxaca Mexico Tlacolula Luz y Vida Chilapa Mexico Chilapa Prevention of Blindness Project Tabasco Mexico Cunduacan Clinica Hospital del Pueblo Anna Seethaler, San Martín A.C. Mexico Mexicapan PBL Baja California Mexico Ensenada Clínica de Ojos - Jinotega Nicaragua Jinotega

Country City Director Ophthalmologist

Argentina Tartagal Claudia Lungu Dr. Juan Carlos Gutierrez

Dr. Carlos Argentina Córdoba Carranza Dr. Carlos Carranza Dr. Jorge Argentina Castelli Kleisinger Dr. Jorge Kleisinger Argentina La Plata Dra. Marta Galán Dra. Marta Galán

Argentina Córdoba Dr. Julio Urrets Dr. Julio Urrets Bs. Aires, La María Eugenia Argentina Rioja Nano

Bolivia Santa Cruz Milton Salvatierra Dr. José Justiniano Bolivia El Alto Yascara Murguia Dr. Rogelio Patti Bolivia Santa Cruz Thomas Dietze Dr. Orlando Torricos Dra. Carmen Bolivia Cochabamba Camargo Dr. Edgar Barrionuevo Dr. Gustavo Bolivia Tarija Aguirre P. Dr. Gustavo Aguirre U.

Dr. Pinheiro, Dr. Ronald &

Nely Carvalho, Dra. Brazil Santarem Janette Ryan Saldanha, Dr Ribeiro Dr. Gloria Brazil Mananhão Vasconcelos Dr. Gloria Vasconcelos Brazil Recife Dr. Liana Ventura Manfred GoebelMaria Conceição da Brazil Cuiaba Encarnação

Chile Concepción Norfa Frez Dr. Raúl González

Dr. Juan José

Colombia Bucaramanga Rey; Isabel Ardila

Cali , Colombia Buenaventura Doris de Botero Dr. Mauricio de Colombia Popayán Rosa Ballén Colombia Pasto Lic. Viviana Díaz Martha Elena Colombia Medellín Betancur Dra. Claudia Durán

Ecuador Portoviejo Yolanda de Avila Ecuador Guayaquil Dr. Eddie Icaza Dr. Eddie Icaza Dr. Felipe Ecuador Yaruquí Chiriboga Dr. Felipe Chiriboga

Ecuador La Libertad Dr. Julio Centeno Dr. Cloro Villamar

Ecuador Loja Dr. Carlos Aguirre Dr. Carlos Aguirre

Dra. Ma del Carmen Dra. Ma del Almeida Dr. Alfonso Ecuador Quito Carmen Almeida Almeida

Ecuador Guayaquil Dr. Eduardo Viteri Dr. Eduardo Viteri

Ecuador Cuenca Raúl Bonifaz Dr. René Cabrera

Ecuador Milagro Dr. Robin Ríos Dr. Robin Ríos Dr. Rainald Paraguay Asunción Duerksen Dr. Rainald Duerksen

Paraguay Asunción Dra. Miriam Cano

Dr. Frilo Silva, Dra. Silvia

Peru Cusco Dr. Frilo Silva Mendoza Dr. Giovanni Peru Arequipa Salas Dr. Giovanni Salas

Dr. Johannes Peru Abancay Kohler Dr. Johannes Kohler

Peru Trujillo Dr. Artemio Burga Dr. Artemio Burga

Peru Piura Dr. Luis Pongo Dr. Luis Pongo

Peru Lima Dra. Luz Gordillo Dra. Luz Gordillo Dra. Maruja Peru Iquitos Limachi Dra. Maruja Limachi Dr. Donald Mejía, Dr. Peru Chachapoyas Dr. José Cajo Francisco Ramos

Peru Lima Dr. Miguel Asmat Dr. Miguel Asmat

Peru Chiclayo Dr. Carlos Labrín Dr. Carlos Labrín Dra. Cecilia Peru Ica Castillo Dra. Cecilia Castillo Peru Trujillo Merly González Merly González Saravia Saravia Dr. Francisco Dr. Francisco Belisario; Venezuela Caracas Belisario Dra. Magally Hernández

Country City Program E-mail rmasociana@arnet.com.ar asocianatartagal@arnet.com.ar Argentina Tartagal Cataract gutierrezdaruich@arnet.com.ar Argentina Córdoba Cataract sec.ver@powernet.net.ar Argentina Castelli Cataract jorgekle@yahoo.com.ar Argentina La Plata ROP digio@way.com.ar

Argentina Córdoba ROP jauz@arnet.com.ar Bs. Aires, La

Argentina Rioja Cataract & ROP menano@clinano.com.ar

aprecia@cotas.com.bo; Bolivia Santa Cruz Cataract josevjt@cotas.com.bo Bolivia El Alto Cataract cmak@kolpingbolivia.net Bolivia Santa Cruz Cataract direccion@fcmakolping.org.bo hpacus@supernet.com.bo Bolivia Cochabamba Cataract edgarbarrionuevo@hotmail.com

Bolivia Tarija Cataract clinojos@cosett.com.bo

Brazil Santarem Cataract brazilnut@netsan.com.br Brazil Mananhão Cataract glvasconcelos@bol.com.br ROP & Low

Brazil Recife Vision projetos@fundacaoaltinoventura.org.br

dahwmt@terra.com.br; Brazil Cuiaba Cataract dgcermac@ses.mt.gov.br

Cataract & Low

Chile Concepción vision direccion@coalivi.cl

saludpublica@foscal.com.co Colombia Bucaramanga Cataract isardila@hotmail.com Cali , Colombia Buenaventura Cataract instituto@telesat.com.co

Colombia Popayán Cataract asoprevisual@emtel.net.co

Colombia Pasto Cataract fundonarino@telecom.com.co martha.betancur@upb.edu.co Colombia Medellín Low Vision gomezduran@hotmail.com

fundacion_olm@yahoo.com Ecuador Portoviejo Cataract sauzaler@ecua.net.ec Ecuador Guayaquil Cataract funcrisa@telconet.net Ecuador Yaruquí Cataract fechifov@interactive.net.ec Ecuador La Libertad Cataract clinicavc@yahoo.com Ecuador Loja Cataract caguirre70@hotmail.com

Ecuador Quito Cataract/ ROP foraf@interactive.net.ec Ecuador Guayaquil Cataract eviteri@ecuadorlaser.com raul_bonifaz@yahoo.com.mx Ecuador Cuenca Cataract repacasa@etapa.com.ec Cataract, Low Ecuador Milagro Vision mmi_ecu@telconet.net

rd@conexión.com.py Paraguay Asunción Cataract, ROP rainaldd@telesurf.com.py Cataract, Low conavip2020@yahoo.com Paraguay Asunción Vision mrcano@uninet.com.py Cataract, Low frilo1sg@yahoo.com ; Peru Cusco Vision dr.silviamendoza@latinmail.com Peru Arequipa Cataract gsfundar@viabcp.com

pedrjo@web.de ; Peru Abancay Cataract obispadoabancay@speedy.com.pe Peru Trujillo Cataract cecom.cbm@gmail.com cimaso27@hotmail.com ; Peru Piura Cataract luispongo@hotmail.com ROP, Congenital Peru Lima Cataract prevista@terra.com.pe Peru Iquitos Cataract asprece@yahoo.es

Peru Chachapoyas Cataract direccion_hrvfch@yahoo.es

asoc.divinoninojesus@terra.com.pe

Peru Lima Cataract miguelasmat@speedy.com.pe provisionperu@gmail.com ; Peru Chiclayo Cataract escuzajorge@gmail.com Peru Ica Cataract gretita_05@yahoo.es Peru Trujillo merlygonzalez2@hotmail.com

ipopular@cantv.net ; Venezuela Caracas Cataract, ROP magallybelisario@gmail.com

9) What are the various advocacy measures implemented in your

region to spread awareness on VISION 2020’s priority areas. Indicate concrete future plans, if any.

Special Number of the CEHJ in Spanish: http://www.revistasaludocular.org/ Regular edition of the December 2008 CEHJ in Spanish:

S. Date

Country Programme /Proposed

No.

date of

Launch

1 Argentina Ongoing meetings with the MOH and National Society of Ophthalmology, so that CEH concepts are included in annual residents meeting, bi-monthly official publication of the National Council of Ophthalmology features a paper related to CEH and one programme.

Low Vision Curriculum for 07/08 Ophthalmologists Forum.

Latin American ROP Workshop. 09/08

III Iberoamerican VISION 2020 08/08 Congress.

I Argentinean Public Health 08/08 Ophthalmology Meeting.

IAPB GA8. 08/08

LARWG annual meeting. 08/08

II Latin American National VISION 2020 08/08 Committees meeting.

2 Bolivia CEH course 05/08

SICS Course 10/08

3 Brazil CEH courses for residency training Second programmes (2) semester 08

National ROP Workshop 11/08

4 Canada

5 Chile

6 Colombia National ROP Workshop 02/08

Committee conveened once again to 04/08 further develop NPBL Plan

CEH Course 04/08

RAAB Study in Barranquilla 08/08

7 Costa Rica Regular monthly meetings of the 08 VISION 2020 committee to promote coordination between agencies and the government in order to establish a

National PBL Plan.

CEH Course 10/08

National ROP Workshop Second semester

LV Training course for optometrists Second semester

8 Cuba

9 Dominican Will conduct a RAAB early 2008 04/08 Republic National ROP Workshop Second semester

10 Ecuador Will conduct RAAB study later in the Second year semester 08

SICS Course Second semester

11 El Salvador Establish National PBL Committee 06/08

12 Guatemala Relaunching on V2020 Committee 10/08 during WSD

Follow up visit as a Priority Country 02/08 along with participation the IEF and Visualiza Sponsored Course

Low Vision Workshop for Central 05/08 America

WHO Regional LV Training Course 11/08

Field Workers primary Eye Care Course Second semester

13 Honduras Presentation of PBL plan during WSD 10/08

CEH Course 10/08

14 Mexico CEH Course took place in Oaxaca and 10/08 RAAB results made available. 08

Ongoing ROP in various districts

15 Nicaragua Workshop with PAHO to update NPBL 08 Plan

Appropriate Technology CEH course Second semester

16 Panama Establish National PBL Committee 08

17 Peru

Follow up RAAB study in the Piura and Second Tumbes Region semester

2009

18 Paraguay Regular ongoing meetings with the 08 Government authorities to launch a campaign of 1000 extra cataract surgeries performed by CONAVIP members.

Cost of blindness and low vision study to start 06/08

CEH Management course 11/08

Quality assurance and Second Procurement/repair of equipment semester workshops

19 United States

20 Uruguay Workshop meetings of the LARWG 03/08 during the Regional PAAO meeting

21 Venezuela

Attachments:

Minutes of the Meeting of the VISION 2020 LA LARWG, held on August 24, 2008 in the Buenos Aires Room of the

Hotel Panamericano, Buenos Aires, Argentina Participants:

1. Dr. Fernando Barría, Co-president of the Advocacy Technical Subcommittee for VISION 2020 Latin America.

2. Dr. Carlos Arieta, President of the VISION 2020 LA Cataract Subcommittee, Brazil.

3. Dr. Fernando Barría, Co-president of the Advocacy Technical Subcommittee for VISION 2020 Latin America.

4. Dr. Juan Batlle, IAPB LA Co-chair, Dominican Republic 5. Dr. Francisco Belisario, Instituto Popular para los Ojos, Venezuela 6. Dr. Miriam Cano, Head of the Department of Ophthalmology, Central Hospital

of the Instituto de Prevision Social (IPS); President, National VISION 2020 Committee in Paraguay

7. Dr. Felipe Chiriboga, Fundacion Oftalmologica del Valle, Ecuador 8. Dr. Francisco Contreras, President of the Prevention of Blindness Committee

of the APO, Peru. 9. Dr. Rainald Duerksen, Chair of IAPB LA and Fundación Visión, Paraguay 10. Dr. Abraham Delgado, President of the VISION 2020 Committee of Nicaragua 11. Ms. Kristen Eckert, Lions Club International Foundation Director for Latin

America. 12. Dr. Pedro Gomez, Director of the Instituto de la Vision 13. Stefan Hancvencl, Programme Officer, Light for the World, Austria 14. Dr. Magally Hernández de Belisario – Instituto Popular para los Ojos (national

public eye institute), Venezuela 15. Prof. Newton Kara José, Co-president, IAPB LA and President, Refractive

Error Subcommittee, VISION 2020 LA, Brazil 16. Dr. Jorge Kleisinger, President of the “Vision Solidaria” program, Argentina 17. Dr. Van Lansingh, Regional Coordinator, VISION 2020 LA, Argentina 18. Dr. Martin Larrea, member, Blindness Prevention Committee of the

Uruguayan Society of Ophthalmology. 19. Marion Martens, VISION 2020 Latin America office 20. Dr. Francisco Martinez Castro, President of the Technical Subcommittee on

Diabetic Retinopathy and the Quarterly Bulletin, VISION 2020 Latin America 21. Dr. Joaquín Martínez, President of the ophthalmology association of Costa

Rica and member of Costa Rica’s V2020 Committee.. 22. Dr. Joan McLeod, ORBIS International, USA 23. Dr. Luz Marina Melo, Executive Director, ASOPREC, Colombia 24. Dr. Enrique Montjoy, President of the Technical Subcommittee on Refractive

Error of VISION 2020 Latin America 25. Dr. Jose Maria Mugica, Medical Director of the Hugo D. Nano Foundation,

Argentina. 26. Dr. Celia Nakanami, UNIFESP, Brazil, representing Dr. Silvia Veitzman,

President of the VISION 2020 LA Low Vision Technical Subcommittee. 27. Dr. Hugo Nano, Director of the Hugo D. Nano Foundation and Co-chair of the

IAPB-LA. 28. Ms. Maria E. Nano, President of the Monitoring Subcommittee for VISION

2020 LA, Argentina 29. Philippe Narval, Program Officer, Light for the World, Austria 30. Dr. Martin Ruppenthal, CBM LARO, Ecuador 31. Dr. Juan Carlos Silva, Regional Eye-Health Consultant to PAHO, Colombia 32. Dr. Andrea Zin, President of the Childhood Blindness Subcommittee of

VISION 2020 LA, Brazil 33. Dr. Jorge Velazco, VISION 2020 Committee of Peru

34. Architect Juan Francisco Yee of the Visualiza Clinic and VISION 2020 Committee of Guatemala.

35. Dr. Mariano Yee, of the Visualiza Clinic and V2020 Committee of Guatemala, and Co-chair of the Social Entrepreneur Technical Subcommittee of VISION 2020 LA

Guests:

36. Dr. Betty Campos, National Institute of Ophthalmology (INO), Peru 37. Dr. Amelia Cerrate, INO, Peru 38. Dr. Victor Dulanto, INO, Peru 39. Ms. Carolina García, BA, Dominican Republic 40. Dr. Patricio Meza, former president of the Chilean Society of Ophthalmology 41. Nelson Rivera, OD, Regional Coordinator of the International Centre for

Eyecare Education (ICEE) for Latin America, USA 42. Dr. Rodriguez, Colombia 43. Dr. Antonio Vera, Colombia 44. Ms. Natalia Zarate, Argentina

Excused:

1. Dr. Doris Alvarado, VISION 2020 of Honduras 2. Dr. Everardo Barojas, Co-chair of IAPB LA, Mexico 3. Dr. Harry Brown, SEE International, USA. 4. Dr. Ray Brown, President of Vision Paraguay, England. 5. Dr. Homero Demicheli, Vision 2020 Committee of Uruguay 6. Dr. Marco de la Fuente, Director of the Department of Ophthalmology of the

Manuel Gea Gonzalez Hospital and Co-president of the Technical Subcommittee on Childhood Blindness for VISION 2020 Latin America.

7. Dr. Virgilio Galvis, Co-chair of IAPB LA, Colombia 8. Dr. Jesus Jimenez, President of the Technical Subcommittee on Glaucoma of

VISION 2020 LA, Colombia. 9. Dr. Lourdes Medina, Co-president of the Technical Subcommittee on Low

Vision of VISION 2020 Latin America. 10. Dr. Marcelino Rio, VISION 2020 Committee of Cuba 11. Dr. Juan Carlos Rueda, President of the Technical Subcommittee on

Glaucoma of VISION 2020 LA, Colombia. 12. Dr. Karen Seidman, Lighthouse International, USA 13. Dr. Silvia Veitzman, President of the Technical Subcommittee on Low Vision

for VISION 2020 LA, Brazil.

Opening: Dr. Rainald Duerksen welcomed all participants and guests at 8:20 AM. Order of the Day:

1) Approval of the Minutes of the 11th Meeting of the VISION 2020 LA LARWG held in Punta del Este, Uruguay on March 6, 2008. The minutes were accepted by those present as a faithful reproduction of the conduct of the meeting. The motion was proposed by Dr. Juan Batlle, and seconded by Dr. Fernando Barría.

2) Letters Requesting Membership in VISION 2020 Latin America The letters, from the International Eye Foundation (IEF), in the United States, Visualiza, of Guatemala, the Fundación para el Desarrollo de la Mujer (foundation for the development of women, or FUDEM), in El Salvador, and the Casey Eye Institute of the United States. Those present who were familiar with the work of those institutions explained the merits of their requests, and all present voted unanimously to accept them as members. We are happy to welcome them. 3) Presentation of technical subcommittee action plans and activities

reports for 2008. The presentations of the cataract, diabetic retinopathy, monitoring, low vision, childhood blindness, advocacy, and social enterprise subcommittees were presented, with the sections that should be integrated into the regional business plan being noted. 4) Membership in VISION 2020 LA Dr. Juan Batlle presented a proposal to consider other groups or persons that are not physicians, NGOs, or related businesses as “associate members”. The proposal also foresee the possibility of individual memberships and that applications be tabulated at one meeting for the purpose of being discussed and voted on in a later meeting. That will give the member of the LARWG time to consult with the VISION 2020 committee and other members from the country in question to verify the merits of the application. In the 2009 meeting Dr. Battle will explain the criteria of inclusion or exclusion for continued membership and the related bylaws and costs. This is very important because the document will also describe the functions to be carried out by the presidents of the technical subcommittees, as well as how to decide on members of the steering committee from among the LARWG members, designate new posts, etc. It is therefore requested that all persons currently occupying executive posts notify Dr. Lansingh as soon as possible to inform him whether they wish to continue in those posts. 5) Excel tool for calculating the prevalence of blindness and required Cataract Surgery Rate The program was developed by Dr. Fernando Y. Peña of Fundación Visión and has been judged a simple and very useful tool by the various subcommittees. A technical problem occurred during the presentation, and so Dr. Van Lansingh will forward a copy to all participants with the minutes of the meeting. 6) VISION 2020 Ambassadors In the 2007 Cancun meeting, a draft of the selection criteria proposed by WHO was presented. Appropriate candidates to assist the task of the advocacy effort and improve the visibility of VISION 2020 in our region will be sought ought by the committee of each country and their technical subcommittees. Dr. Luz Marina Melo advised us that unfortunately it has not yet been possible to obtain a commitment from Mr. Carlos Vives, a well known Colombian singer and songwriter. Dr. Duerksen has ensured the participation of Mr. Jorge Castro, a well known Paraguayan Tenor, while Ms. Maria Eugenia Nano has

confirmed the participation of her sister, Adriana, a Tango singer twice nominated for a Grammy Award. It is requested that everyone redouble their efforts to obtain more commitments from cultural figures with an international reputation. 7) Presentation of the Draft Guide for Cataract. Dr. Luz Marina Melo presented the draft of a Guide to Cataract, which follows a format similar to that of the guide to ROP for Latin America, and which will be presented at a later meeting. The final document will be circulated by Dr. Carlos Arieta in December. 8) Presentation of the schedule of activities and courses for the remainder of 2008. The schedule was presented by Dr. Van Lansingh, with no amendment being offered by any participant. 9) Selection of new regional and international officers of the IAPB. Mr. Christian Garms is the new Chair of the IAPB; Professor Hugh R. Taylor the new Vice-Chair; Mr. Larry Hansen serves as the new Executive Director, and Mr. Peter Ackland is the new Director of Programmes. Dr. Rainald Duerksen continues as Regional Chair for Latin America. We wish them all the warmest welcome and congratulations, and are pleased to express our sincere desire to work with them to achieve the goals and objectives of VISION 2020. 10) Formation of the new Technical Subcommittee on Social Enterprise Dr. Mariano Yee of the NGO Visualiza in Guatemala is the leader of this new undertaking. He will be charge, in cooperation with the IEF and new members of the LARWG with broad experience in the field, of finding ways to obtain better financing, promotion, and identification of NGOs in the field that promote the concepts of sustainability and solidarity. 11) Summary of Epidemiological Data on Eye Disease Dr. Lansingh explained that the intention is to publish a summary of the data reported during the last five years, even when these are not from peer-reviewed journals, in order to have a baseline for country-by-country analysis with which to monitor any possible progress or to define areas for future research. The summary is being created by 3d-year residents from the Hugo D. Nano Ophthalmology Foundation under the supervision of Ms. Nano and Dr. Lansingh. Some have already forwarded a list of publications. Those who have not are asked to do so before 30 October 2008. 12) World Sight Day 2008 Ms. Abi Smith, IAPB Communications Manager gave a very interesting presentation that is available in English and Spanish. Interested parties should send a request in writing to Dr. Van Lansingh. In her presentation she explained the purpose and objectives of World Sight Day as well as explaining the suggestions and the theme for this year, "Eyes on the Future", which will be held on Thursday 9 October. For further information, please see: http://www.v2020.org/page.asp?section=0001000100070011

Dr. Juan Carlos Silva of PAHO will also carry out the needed advocacy to make sure that from now on, the day will be officially observed in the calendar of this important partner of ours. 13) PowerPoint presentation on the importance of obesity An interesting presentation highlighting the relationship between the metabolic syndrome and its consequences for our eyes. It was prepared by Dr. Francisco Martinez Castro, and is available in Spanish upon written request made to Dr. Van Lansingh. 14) Special IAPB Pre-Assembly Edition of the Spanish-language Edition of the Community Eye Health Journal and Quarterly Bulletin of VISION 2020 Latin America We believe that it will be of great interest to many to read of the happy experiences of doing advocacy in the region, the magnitude of refractive error, what NGOs are doing, and news of useful resources, among other things. Just click here: http://www.revistasaludocular.org/ and here http://www.v2020la.org/bulletin/esp/docs/boletin_13/index.html 15) Presentation by the Lions Club The presentation was made by Ms. Kristen Eckert, Lions Program Coordinator for Latin America. All present expressed their pleasure at the renewed interest and activism of the Lions Clubs in blindness prevention activities in the region. An example of this is their cooperation with Fundación Visión in establishing a community eye-health center for training medical professionals in the region. 16) Report on Priority Countries As has been previously reported, the priority countries in the region are Guatemala, Peru, and the Dominican Republic. A very comprehensive report on the three countries has been prepared, and was presented by Dr. Miriam Cano. It is available in both Spanish and English. If you would like a copy of the summary or the complete report, please request it in writing from Dr. Van Lansingh. 17) Presentation of Reports on the Achievements and Plans of the National Vision 2020 Committees of Latin America. Each country represented gave a presentation on these topics that was very interesting and which resulted in allowing the exchange of experiences and suggestions among all those present. If you would like a copy of the PowerPoint presentation for a particular country, please request it in writing from Dr. Van Lansingh.

18) Upcoming meeting of the LARWG

Dr. Lansingh will be in touch to advise LARWG members of the schedule. The meeting is normally held in conjunction with one of the larger medical conferences, but as there is no World Ophthalmology Congress scheduled for next year, and the PAAO Conference will be held near the end of October 2009, jointly with that of the American Academy of Ophthalmology, in San Francisco. Suggestions are welcome!

With no other business to be concluded, the session was ended at 8:30 PM.

Report

Second Latin American Retinopathy of Prematurity (ROP) Workshop and

Joint meeting with the V Congress of Sociedad Iberoamericana de

Neonatología (SIBEN)

Mar del Plata, Argentina

September 15-17, 2008

Facilitators: Clare Gilbert, FRCOphth, MD., MSc. International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK Graham E Quinn, MD, MSCE, Division of Pediatric Ophthalmology, The Children’s Hospital of Philadelphia and Professor of Ophthalmology, University of Pennsylvania Health System, Philadelphia, Pennsylvania. Andrea Zin, MD, MSc. Neonatology Department, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil Marco de la Fuente, MD MSc. Chief of Ophthalmology Division, Hospital Manuel Gea Gonzalez, México City, México Licenciada Ana Quiroga, Escuela de Enfermería Universidad Austral, Ministerio de Salud de la Nación, Argentina Augusto Sola, President of Siben Sponsors: Christoffel Blindenmission PAHO The second, region-wide Latin American Workshop on Retinopathy of Prematurity (ROP) was held

immediately before the regional neonatology meeting (the V Congress of the Sociedad

Iberoamericana de Neonatología (Siben)). A one day seminar on ROP was also held during Siben for

those attending the Congress. The meetings took place in Mar del Plata, Argentina from September

15-17, 2008 with support from CBM (Christoffel Blindnenmission), Panamerican Health Organization

(PAHO) and Iridex.

The purpose of the 2 day workshop was to provide up to date information on ROP as a cause of

blindness in Latin America and on current ROP programmes in order to improve existing programmes

and plan new ones.

The workshop was attended by 41 participants from 13 countries (Argentina, Bolivia, Brazil, Chile,

Colombia, Dominican Republic, El Salvador, Guatemala, Mexico, Nicaragua, Peru, Venezuela and

Uruguay), included neonatologists, nurses and ophthalmologists. Facilitators were Dr Augusto Sola,

President of Sociedad Iberoamericana de Neonatologia, Dr Graham Quinn, paediatric ophthalmologist

from the Children’s Hospital of Philadelphia, University of Pennsylvania, USA, Prof Clare Gilbert, from

the International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Nurse Ana

Quiroga, Ministry of Health (Argentina), Dr Marco de La Fuente (Mexico) and Andrea Zin (Brazil), both

CBM medical advisors and IAPB chairs for childhood blindness (Appendix 1 for time table).

The purpose of the one day seminar during the Siben Congress was to increase awareness of ROP

among neonatologists and nurses in the region, and to emphasize the critical role they can play in

preventing the condition and in reducing blindness (Appendix 2 for time table). At least 700 of the

1,200 delegates attended the seminar.

Background

Retinopathy of prematurity is, to a large extent, a preventable cause of blindness. There are two main

approaches to control: good neonatal care to reduce risk factors (e.g. better monitoring of

supplemental oxygen; reduction in sepsis and stress; better nutrition) and programmes whereby

ophthalmologists visit neonatal units to examine babies at risk, and apply laser treatment to those

eyes that develop “type 1” or worse ROP. A multidisciplinary approach is, therefore, needed involving

neonatologists and neonatal nurses, ophthalmologists and parents. Support from Ministries of Health

is essential, as well as support to implement ROP programs by non-government organizations.

Advocacy will be required.

Each year there are approximately 10,500,000 live births in Latin America. Approximately

100,000 are born premature and weigh less than 1,500g (1%) at birth, and 60% (60,000) of these

babies have access to neonatal care. The overall survival rate in babies weighing 1,500g is around

60% which means there are estimated to be 42,000 premature babies each year who are at high risk

of ROP, all of whom require screening for ROP. According to data from the region, babies with higher

birth weights (up to 2000gs at birth) are also at risk of ROP and so the number of babies in the

region who need to be examined each year is likely to be at least 60,000. The proportion of babies

examined for ROP who develop the severe stages of the disease where treatment is indicated varies

from neonatal unit to neonatal unit, but it is estimated that at least 4,000 and maybe as many as

6,000 babies will benefit from treatment each year in Latin America.

The first region-wide Latin American ROP Workshop was held in Peru in 2005. This was the

first time neonatologists, nurses and ophthalmologists from 18 countries of the region had the

opportunity to meet since the very first workshop which was held in Quito in 1997. In 2005

participants concluded that:

• ROP was an important cause of blindness in children in the region.

• In some countries the proportion of blindness due to ROP was increasing, although not all

countries have data on the causes of blindness in children.

• There are many challenges to increasing coverage of ROP programmes. Lack of financial

reimbursement for time spent by ophthalmologists on the programme is a major factor.

• Meticulous neonatal care is essential for decreasing the risk of severe ROP.

• Each country identified key activities to be undertaken over the next 3 months, and over the

next 12 months (report of First Latin American ROP Workshop).

The recommendations that emerged from the participants were:

• To collect data on childhood blindness causes using the WHO methodology

• To perform a situational analysis of the number of neonatal units, preterm babies at risk of

developing severe ROP and availability of human and financial resources and infrastructure.

• To develop regional guidelines for ROP management

• To improve awareness with parents, governments, health care personnel

• To develop a monitoring and evaluation tool

The poster presentations and discussions at the second regional workshop enabled the progress

different countries had made to be documented.

SUMMARY OF ACTIVITIES:

September 15

The workshop was opened by Dr Sola, President of Siben, who welcomed participants. Dr Zin

presented the purposes of the meeting and the activities of the IAPB Childhood Blindness Committee

followed by Prof Gilbert who gave a presentation on ROP as a cause of blindness globally and in Latin

America. Dr Sola discussed possible interventions to prevent ROP from the perspectives of

neonatologists and nurses. Dr Sola stressed the importance of collecting information as it is necessary

“to prove in order to improve” i.e. information and data are essential for evidence, advocacy and

monitoring. A recent study has shown that there is still a huge gap between what is known with

respect to aspects of neonatal care which would prevent ROP (and reduce other adverse neonatal

outcomes) and what is currently being done – efforts need to focus on implementing what we already

know prevents ROP. After Dr Sola’s presentation, Dr de la Fuente presented a report of the workshop

held in Lima.

Information on the current situation of countries ROP screening programmes was provided during 2

poster sessions: the first one was on September 15 (Argentina, Bolivia, Brazil, Chile, Colombia,

Dominican Republic, and El Salvador) and the second (Guatemala, Mexico, Nicaragua, Peru,

Venezuela and Uruguay)non the following day.

The afternoon was dedicated to group work. Participants were divided into groups to discuss the

challenges and solutions to implementing ROP programmes:

Group work session 1; Topics for discussion:

1. What are the limitations of current programmes for case detection?

2. How could these be overcome?

3. What concrete steps can be taken to improve the quality of current case detection and treatment

programmes?

Participants highlighted the following:

Human resources: Lack of trained nurses, neonatologists and other support staff who are often poorly

distributed. Training curriculae need to be included at all levels for medical and nursing training and

for training support staff.

Relationships between neonatologists and ophthalmologists are not always good and need to be

improved by increasing awareness of each others’ challenges and constraints. ROP needs to be seen

as a joint problem with joint solutions.

Equipment: There is not always enough equipment for delivering and monitoring oxygen, as well as

for examining the preterm babies at risk (indirect ophthalmoscopes, lens, lid speculum) and

inadequate equipment for treating ROP.

Political will and financial support: Lack funds for equipment, adequate staff and to cover costs of

screening and treatment limit implementation of programmes. In several countries of the region there

is no national policy or any law regulating that preterm babies at risk should be examined, and

treated when severe ROP is diagnosed.

In order for programmes to become sustainable it is important that there is advocacy with policy

makers and service providers so that more resources are made available for preventive measures and

to cover the costs of running ROP programmes. This will mean that control of ROP needs to be made

a higher priority which can be done by highlighting the fact that better neonatal care will contribute

towards achieving Millenium Development Goals. Ministries of Health are also expected to develop

and implement national prevention of blindness plans. It is important that all countries in the region

include prevention of ROP blindness in their national prevention of blindness plans.

Lack of data and poor organization: Reliable information is not always routinely collected to help plan,

implement and monitor ROP programmes.

Awareness: Parents and the community do not know about ROP. Education and awareness raising

among parents and the community is also very important and has not been prioritized in many

programmes.

A second group work session was dedicated to the update of the Latin American Guidelines. Nurses,

neonatologists and ophthalmologists all contributed.

September 16

Dr Luz Gordillo opened the second day of the workshop talking about the need for follow-up of pre-

term babies. Premature babies are at increased risk of significant refractive errors, particularly

myopia, strabismus and amblyopia compared with full term babies. They may also have visual

impairment from ROP as well as from lesions of the higher visual pathways (optic nerve, visual

cortex, and higher association areas).

The second poster session on information of ROP programmes was held for: Guatemala, Mexico,

Nicaragua, Peru, Uruguay and Venezuela.

Participants were divided into groups to discuss common challenges where countries could coordinate

efforts. The areas discussed included: training in examination and treatment; management

information systems (minimum dataset); planning, monitoring and evaluating programmes;

information for parents and providers; advocacy and information for policy makers and prevention of

ROP through education and awareness among nurses and neonatologists and how experiences in

other countries be used to address these challenges

Country achievements:

A. Countries that have started programmes since 2005:

Dominican Republic and Guatemala have started to implement screening and treatment

programmes. Neonatal units are poorly equipped and training of health care personnel is needed.

In Dominican Republic there are 8 neonatal units in the governmental sector and 15 private units. Six

of the government units sector have screening and treatment programmes, whereas none of the

private have access to this service. Neonatal care needs improvement regarding equipment and

human resources. Only 40% of NICUs have blenders, CPAP or mechanical ventilation. Thirteen

percent of examined preterm babies develop severe ROP (BW< 2500g; GA < 37 wks).

B. Countries which have an increased emphasis on prevention:

Argentina: coverage of screening and treatment programme is similar to 2005 with over 2/3 of

neonatal units having a programme (113/158). The ROP Collaborative Working Group, established in

2003 and supported by the Ministry of Health, provides regular training and monitoring of the

programme. Information is available, but still there is lack of human resources and equipment. Since

2006, other treatment centres have been established in Argentina. The Ministry of Health

implemented a strategy to decrease the number of babies developing severe ROP, consisting of

training of personnel, provision of equipment, implementation or enforcement of norms (oxygen

supply & ophthalmologic examinations). They expanded this initiative to 30 NICUs in the country and

so far the number of treatments for ROP has decreased substantially.

Peru: In 2006, Ministry of Health of Peru signed a Resolutión Ministerial (No 422-2005/MINSA), June

8, 2006, which approved Guidelines for Clinical Practice. The National Guidelines for ROP were

approved by the Ministry of Health. Many programmes are being expanded outside Lima. ORBIS

international are supporting a programme of prevention which entails one week training of all staff

working in 15 NICUs in Lima, and better equipment for administering and monitoring oxygen. Rates

of ROP needing treatment and the number of children presenting to Dra Luz blind from ROP will be

used to monitor the impact of the training.

El Salvador: The Ministry of Health has approved national guidelines for Management of preterm

babies with birth weight < 2,000g (”Guía Técnica para el seguimiento del recién nacido prematuro

menor de 2000 gr. al nacer”), which includes ROP screening and treatment. All 6 governmental units

of the country have access to this service. However, the ROP programme needs to be expanded to

the private units. At least at Hospital Nacional de Maternidad, one of the national referral centres for

high risk pregnancies, the rates of severe ROP are decreasing as a result in improvement in neonatal

care.

C. Countries which have improved in other ways:

Chile: Chile has a very comprehensive national programme that assures all preterm babies born in

the country to have access to eye exam and treatment of ROP (garantias explicitas de salud). There

are now 6 centres for laser therapy and 1 centre has been developed to treat babies with Stage 4 or

5 ROP. Ministry of Health supports all aspects of the programme.

Brazil and Mexico: Both countries have many similarities and the coordination of a national

programme in both countries is a challenge.

o Ophthalmologists have a good level of training, but availability of professionals

adequately trained in governmental units is a challenge.

o Distribution of equipment to diagnose and treat is also not adequate. As a

consequence, screening and treatment coverage is insufficient in the 2 biggest

countries of the region, approximately 50%.

o Neonatal care needs improvement as NICUs are not all fully equipped to provide

oxygen delivery safely, as well other aspects of neonatal care needs improvement.

Opportunities for education is scarce for neonatal nurses.

o The Ministry of Health in Mexico is analysing the official Mexican guideline (NOM

- Norma oficial mexicana) 34 SSA2-2000, probably by the end of 2008

there will be an official and obligatory law that assures that all preterm

babies have access to exam and treatment.

o Ministry of Health of Brazil is reimbursing examination and treatment for

ROP at governmental level.

o Both countries established screening and treatment guidelines in 2007.

D. Countries that have expanded their programmes:

Several countries expanded their screening and treatment coverage, e.g. Argentina, Brazil, Ecuador,

Colombia, Peru, Mexico and Venezuela. Ministries of Health have been involved in many ways,

collaborating with National Societies, ophthalmologists, neonatologists and nurses.

E. Countries where ROP prevention is very critical

Nicaragua: It is estimated that at least 500 babies would need screening for ROP every year and

that approximately 50 would benefit from treatment. Only 5 of the 17 NICUs in the country have an

ROP programme. There is no training in neonatology in the country, with a serious shortage of

neonatologists and nurses. Also training of ophthalmologists is very difficult. There is no laser in the

country but cryo is available. Fifteen percent of examined babies develop plus disease (screening

criteria BW < 1 800 g; GA < 35 wks).

F. Countries not represented at the workshop, but that sent reports:

Ecuador: The ROP screening program was extended from 4 neonatal units at the beginning of the

program in 2003 to 16 neonatal units by December 2007. An increasing number of children screened

and treated were the result of implementing this project (see below). This data was obtained during

the national workshops on ROP usually done at the beginning of each year.

2004 2005 2006 2007 # Examined Patients 534 1088 1551 1741 # Patients with ROP 134 205 225 336 # treated Patients 25 44 65 73

Ecuador has now a National Plan for Blindness Prevention for ROP that was approved by the Ministry

of Health. The same standardized form is used in all neonatal units. A standardized protocol for

oxygen administration in these babies is used in all neonatal units. Health Education Material for

preventing Blindness for ROP is available for parents and doctors. Thanks to the amount of

information (brochures, posters placed in neonatal units, TV interviews, articles written in

newspapers, etc,) mothers and doctors are more aware of the importance of screening premature

babies.

Paraguay: There are nine govermental NICUs, of which 6 have implemented ROP screening and

treatment programmes, but none of the 9 private NICUs have a programme in place. Forteen percent

of examined babies develop severe disease (screening criteria BW ≤ 1,750g; GA ≤ 34 wks). All the

activities are supported by Fundación Visión and so far government has very little involvement.

September 17

The 3rd day of the workshop was held in Costa Galana Hotel, venue of the V Siben Congress. It was

an excellent opportunity for advocacy to 700 neonatologists and nurses from Latin America who

attended the ROP session called ROP in Latin America: Where are we and where are we

going?

Conclusions:

1. ROP remains as in important cause of avoidable childhood blindness in Latin America. However

there is still lack of information about current causes of childhood blindness in the great majority

of countries.

2. Retinopathy of prematurity prevention requires a comprehensive approach: good antenatal care,

improvement of neonatal care (primary prevention), diagnosis and treatment of ROP (secondary

prevention) and visual (re)habilitation (tertiary prevention). All countries in Latin America need to

address all 3 levels in order to decrease childhood blindness due to ROP.

a. Human resources:

i. There is still a need to train ophthalmologists to screen and manly to treat.

ii. Lack of knowledge: need to improve level of training of neonatologists,

nurses

b. Equipment needs

i. Primary prevention: blenders, oxymeters

ii. Secondary prevention: lack of indirect ophthalmoscopes and lasers

iii. Tertiary prevention: low vision aids. There are very few low vision

programmes, specially those dedicated to the children

3. Most countries are following similar policies and practices for screening and treatment. The Latin

American Examination and Treatment Guidelines were revised with emphasis on the utilisation of

broader screening criteria. Guidelines were also developed for the use of oxygen and treatment

management by neonatologists and nurses.

4. With support from ministries of health and international and local non-government organizations

ROP programmes are expanding in many countries in Latin America. National ROP Committees

have been formed and management information systems developed. Latin American Neonatal

and Ophthalmological guidelines were written in 2006 and updated in October 2007, January

and September 2008.

5. Detection of cases is improving in many countries; however, access to treatment services is

complicated in several countries.

6. There is a high number of “unusual cases” (babies with BW > 1500g and severe ROP) and

missing opportunities implying that much could be done to reduce the incidence of ROP.

7. Neonatal care in Latin America is still critical in several countries with gaps in technical and

human resources. There are few opportunities for education and training of nurses and

neonatologists. Rates of ROP should be used as an indicator of levels of neonatal care.

8. Programme management

a. Data are not being collected in a standardised manner.

b. Detailed written protocols need to be developed, approved by the National

Committee, and used throughout the national programme

Recommendations

1. ROP as a cause of blindness:

More data are needed on ROP as a cause of blindness.

Action

1.1 There is a need to collect these data where they are currently not available, and, if possible, to

repeat data collection every 10 years, to monitor trends over time

1.2 Ideally the World Health Organization’s Prevention of Blindness methodology and classification

should be used, so that data are comparable between countries and over time. Available from

Clare Gilbert, ICEH

1.3 These data need to be published and presented at meetings, to increase awareness of the

problem of ROP blindness and so as “to prove, to improve”

2. Situation analysis:

Countries improved the knowledge of the extent of their screening programmes. Also there is a better

understanding of the needs

Action

2.1 That a situation analysis continue to be undertaken in countries to provide information on the

number of units in the country, and the provider; the number of preterm babies at risk, and the

extent to which the screening programme is meeting this need. This information is essential for

planning.

3. Increasing coverage:

There are many challenges to increasing coverage of ROP programmes. Lack of financial

reimbursement for time spent by ophthalmologists on the programme is still a major factor

Action

3.1 Countries in the region with well established programmes can assist those countries where

programmes have only just started, particularly in terms of training in screening and treatment

as well as different aspects of neonatal care. This could be done through a well developed plan

of ongoing support and partnership.

3.2 To develop sustainable programmes, government support is required. This will need advocacy

and lobbying, highlighting that improvement of neonatal care will help to meet the Millennium

Developmental Goals

3.3 That countries publish their experiences and findings, so that programmes can learn from each

other.

4. Follow up of premature babies:

Late sequelae (ophthalmological and systemic) are much more common in premature than in full

term babies. Long term follow up of premature babies regardless of ROP status, is therefore

required, to identify and manage problems, some of which are sight threatening.

Action

4.1 Appropriate, realistic guidelines need to be developed, to make sure babies most at risk are

followed up

4.2 Health education and awareness of the need for follow up should be included in information for

parents

4.3 Planning and advocating for peadiatric and ophthalmological services for long term follow up

should be part of ROP programmes

5. Awareness:

Many countries have produced health education materials for parents, the general public, and for

health care providers (neonatologists and eyecare providers). However, more still needs to be done to

increase the profile of ROP in many countries.

Action

5.1 Countries need to make sure that raising awareness is explicitly included in their programmes.

This can be achieved through publications, the mass media etc.

5.2 Given the common language throughout the region, educational materials should be made widely

available, possibly through the IAPB website.

5.3 Different aspects of ROP and ROP control programmes need to be included in the curriculae of

nurses, ophthalmologists, paediatricians and neonatologists.

5.4 Continuing education for ophthalmologists, neonatologists and nurses should also include ROP

6. Monitoring and evaluation of programmes:

Each country needs to decide the minimum essential information needed to monitor and evaluate

their programme, from the perspectives of coverage, and quality.

Action

6.1 That a standard reporting form, database, and statistical package be used throughout the region,

if possible: CLAP/PAHO Dr Jose Luis Rossello

7. Regional neonatology group:

Meticulous neonatal care is essential for preventing ROP

Action

7.1 That the regional group of neonatologists and nurses keep addressing issues of relevance to the

prevention of ROP.

8. Communication:

Sharing of information of relevance to all aspects of ROP and its control is important in preventing the

disease and improving programmes. At the recent regional meeting in Panama it was agreed that a

CD of all relevant information be produced and made widely available.

Action

8.1 A website (www.prorop.com) is being developed by the Federal University of Rio Grande do Sul in

Spanish, Portuguese and English, under the support of the PAAO. It will provide information for

health care personnel, parents and will give the chance to share ideas and discuss problems and

their possible solution. It will be available in 30 days.

Other:

http://www.rop21.com.ar

http://www.boostnz.info/ROP/

Output

• Updated situational analysis

• Improved neonatal care guidelines on how ROP needing treatment might be prevented

• Revised guidelines on all aspects of ROP programs, including neonatal and ophthalmologic

components

• Plans to improve the quality of current ROP programs:

• Courses to NICU health care personnel, practical guidelines for ROP programmes

• Annual budgets for the above plans

• A list of indicators to monitor and evaluate progress

• Number of courses to health care personnel/country/year

• Number of trained health care personnel

Plans for 2009

ROP Workshop Bolivia

ROP Workshop for Centroamerica

APPENDIX 1 TIMETABLE ROP Workshop: Mar del Plata, Argentina September 15-16, 2008 (Monday, Tuesday) Hotel Iruña Purpose: Update information on ROP as a cause of blindness in Latin America and on current ROP programs in order to improve existing programs and plan new programs and initiatives for prevention Objectives: Experience and expertise of the participants will be used to: Identify the need for ROP examination and treatment of at risk babies, by country:

• information on the epidemiology of ROP (i.e. magnitude of the blindness due to ROP in children; incidence of ROP in preterm and low birth weight babies; characteristics of infants with severe ROP i.e. birth weight and gestational age)

• revise estimates of the number of preterm babies who need to be examined and number of those needing treatment

Describe services for premature babies:

• determine number of NICUs with and without ROP programs, and estimate the coverage (i.e. % of babies at risk who are included in ROP programs)

• current levels of care for preterm and low birth weight babies in the different health care sectors

• identify current policies and practices: e.g. transport arrangements for outborn babies; labor ward resuscitation practices – 100% O2 or air or blended; nurses’ role in neonatal care

• identify key areas where neonatal care practices may be improved to prevent ROP

Review current ROP programs – clinical aspects: • identify current ROP examination and treatment practices for preterm and low birth weight

babies (e.g. criteria for examination; timing of examinations; indications for treatment) • review the Regional ROP examination protocol in use • identify strengths, weakness, opportunities and threats • make recommendations concerning developing or strengthening programs for ROP

examination and treatment of preterm and low birth weight babies at risk

Review current ROP programs – managerial / other aspects: • existence and activities of National ROP Committees • analyse the organization and management of existing ROP programs e.g. responsibilities and

interests of different stakeholders (e.g. pediatrician, neonatologist, nurse, ophthalmologist, parents)

• elaborate how the interaction and cooperation between different involved stakeholders can be optimized (regarding both ROP examination and treatment)

• analyse the underlying governmental regulatory framework including governmental support

Output: 1. Updated situational analysis 2. Improved neonatal care guidelines on how ROP needing treatment might be prevented 3. Revised guidelines on all aspects of ROP programs, including neonatal and ophthalmologic

components 4. Plans to improve the quality of current ROP programs 5. Plans to increase coverage of ROP programs to units which do not currently have programs 6. Annual budgets for the above plans 7. A list of indicators to monitor and evaluate progress Important information for participants – This workshop provides a unique opportunity for those involved in caring for babies at risk of ROP, and those involved in examinations and treatment of ROP, to share experiences, and to address issues that are common across the region. For this reason, ample time has been allocated during the workshop for group work. Participants from each country should present the country information in poster format. It is suggested that

• nurses and neonatologists produce a poster with information on neonatal care • ophthalmologists produce a separate poster with information ROP examination and

treatment. Posters (2 per country) should focus on: Nurses/Neonatologists

• Situation in each country regarding neonatal care: o Number of units in the country:

� Number with ROP programs � Number without ROP programs

Suggested format: Government NICUs Private NICUs University NICUs Total With ROP program Without ROP program Total:

o Total of live births, by birth weight and gestational age groups � Birth weight groups: <1000g, 1001-<1500g, 1500-<2000g, 2000-<2500g,

2500g or more � Gestational age groups: <30 wks, 30-<34 wks, 34-<37 wks, 37 wks or more

Suggested format: Admitted (N) Mortality rate (%) Survive (N) <1000g 1001-1499g 1500-1999g 2000-2499g 2500g+ Total: Admitted (N) Mortality rate (%) Survive (N) <30 weeks 30-<34 weeks 34-<37 weeks

37+ weeks Total:

o Labor ward resuscitation practices – 100% O2 or air or blended o Number of neonatologists and nurses per bed in units o Number of nurses/shift/incubator in high and intermediate risk o Different ways to give oxygen to the newborn and how do you monitor the oxygen o Inservice NiCU training for nurses and neonatologists available? If yes, which kind? o Neonatology training available in the country? National Society of Neonatology?

Opthalmologists • Situation in region regarding ROP examinations and treatment:

• National committee in place? • Support from government o Coverage: total number of NICUs and number of NICUs of examination

programmes (i.e. the % of units that have examinations programs) o examination criteria

� method of examination � frequency of examination

o rates of treatment � BW and GA of babies needing treatment � available methods of treatment � treatment undertaken in OR, NICU or transported to other facility � Anaesthesiologist available for treatment /sedation by neonatologists

o Training of ophthalmologists to examine and treat available? � How it is being undertaken? Training of residents?

o rates of follow up after discharge til risk of progression is low o follow up in Pediatric clinics o links to low vision services o collaboration between neonatologists and ophthalmologists

Common information (participants will decide who should present this) o Good experiences o challenges and constraints o Advocacy for parents, National Societies, government o Plans for the next 3 years o Educational material developed (to bring samples)

Day 1 Monday September 15th 2008 8:00-8:45 Posters put up

9:00 Welcome and Introduction Sola

9:15 Objectives of the Workshop Zin

9:25 Activities of IAPB Childhood Blindness Committee/Others ICH Zin 9:30 ROP as a cause of blindness Gilbert 9:40 Interventions to prevent ROP Sola

9:50 Report of Lima Oct 2005 Workshop Fuente

10:00-12N View posters from: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador

12:48 Lunch

2:00

Group work session 1 with feedback 4. What are the limitations of current programmes for case detection? 5. How could these be overcome? 6. What concrete steps can be taken to improve the quality of current case detection

and treatment programmes? 3:30 Break

3:50

Group work session 2a with feedback - ophthalmologists: Can a standard protocol / best practice guidelines be developed for the region on: 1. Information given to parents by ophthalmologists 2. Screening criteria 3. Timing, method, frequency and place of examinations, and ensuring

follow up 4. Indications and consent for treatment 5. Method of treatment, and follow up after treatment 6. Training in examination and treatment 7. Follow up of premature babies 8. Referral to low vision / rehabilitation programmes for children with

visual impairment from ROP 9. Data to be collected for monitoring and evaluating programmes Group work session 2b with feedback - neonatologists: Can a standard protocol / best practice guidelines be developed for the region on: 1. Minimal acceptable standards for oxygen monitoring 2. Information given to parents by neonatologists with respect to ROP 3. Identifying and recording babies needing examination (who and how) 4. Care during examination in intensive care 5. Ensuring discharged and treated babies attend for follow up 6. Care during laser/cryo treatment 7. Follow up of premature babies by pediatricians 8. Data to be collected for monitoring and evaluating programmes

4:45 Group feedback Day 2 Tuesday September 16th 2008 (continued):

8:00-8:45 Posters put up

9:00 Need for follow up of premature babies Gordillo

9:15 – 11:30 View posters from: Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela

11:30 Break

11:50 Group work session 4: What are common challenges in which can countries coordinate efforts? 1. Training in examination and treatment 2. Management information systems (minimum dataset) 3. Planning, monitoring and evaluating programmes 4. Information for parents and providers 5. Advocacy and information for policy makers 6. Prevention of ROP through education and awareness among nurses and neonatologists

What challenges are unique to countries? 1. How can experiences in other countries be used to address these challenges?

13:00 Feedback

14:00 Lunch

Afternoon

Conclusions and recommendations

Committee to work on preparing conclusions for presentation at SIBEN meeting SIBEN Meeting ROP in Latin America: Where are we and where are we going? Facilitators: Gilbert, Zin, Sola, Quinn, de la Fuente, Quiroga Wednesday September 17, 2008 Hotel Costa Galana (9:00 AM TO 5:00 PM) 9:00 Welcome and Introduction Bauer, Sola 9:10 Meeting Objectives A Zin 9:15 ROP as a cause of blindness: An international perspective C Gilbert 9:45 ROP as a cause of blindness in LA. Summary of the II LA ROP Workshop Zin 10:15 New mechanisms on ROP genesis Chemtob 10:35 ROP pathophysiology Stiris 11:00 Break 11:20 Classification of ROP de la Fuente 11:40 Detection of serious retinopathy: current and alternative methods Quinn 12:00 Current treatment options Quinn 12:20 ROP from a neonatologist’s perspective: Primary prevention Sola 12:40 Nurses’ role in the prevention of ROP Quiroga 13:00 Break 13:30 Lunch and Abstracts presentation

Group 1: abstracts 3 and 4- Moderators Sola and Zin Group 2: Abstracts 1, 2, and 5 – Moderators Quinn and Gilbert

14:30 Break

15:00 Round table: Zin, Gilbert, Quinn, de

what has worked in various countries and what hasn’t worked? Suggestions from the floor on new approaches to implementing programs?

la Fuente, Benitez, Quiroga

15:30 Action plan for prevention. Conclusions and recommendations

II Latin American ROP Workshop Mar del Plata Argentina September 15-17 2008

List of participants

Ophthalmologists Country email

South America

Julio Manzitti Argentina juliomanzitti@hotmail.com

Marta Galan Argentina digio@way.com.ar

Gustavo Aguirre Urquizu Bolivia clinojos@cosett.com.bo

Alexia Romanelli Bolivia ale2rom@yahoo.com

Joao Borges Fortes Brazil jbfortes@cursohbo.com.br

Juan Pablo Lopez Chile jpablolopezg@hotmail.com jpablolopez@123.cl

Claudia Zuluaga Colombia czuluaga@imbanaco.com.co

Luz Gordillo Peru prevista@terra.com.pe

Leonora Martinotti Uruguay leonoram@adinet.com.uy

Edwin Martinez Venezuela edwinmartinez50@gmail.com

Maria Alejandra Rodriguez Venezuela mljndra21@gmail.com

Central America and Caribbean

Juan L. Ubiera Dominican Republic juanl.ubiera@codetel.net.do

Finella dell Arciprete de Rottmann El Salvador finellarottmann@yahoo.com

Maria Eugenia Sanchez de Oliva Guatemala olivaeu@hotmail.com

Luis Porfirio Orozco Gomez Mexico luisporozco@prodigy.net.mx

Rommel A. Izaguirre Nicaragua drolhorommar@mnmail.com

Neonatologists

South America

Alicia Benitez Argentina ambenitez@intramed.net

Celia Lomutro Argentina clomuto@ucmisalud.gov.ar

Ernesto Alda Argentina eralda@criba.edu.ar

Luis Ahumada Argentina luisahumada@gmail.com

Teresa Sepulveda Argentina atsal@fibertel.com.ar

María Inés Martinini Argentina mimartinini@hotmail.com

Lidia Galina Argentina lgalina@intramed.net.ar

Juan Manuel Jijena Duran Bolivia clinojos@cosett.com.bo

Shirley Yolanda Cuenca Rocabado Bolivia shirdoc@hotmail.com

Clara Galviz Colombia gdclari@gmail.com

Ana Maria Villanueva Peru deamvillanueva@yahoo.com

Aura Mayela Illas de Gonzalez Venezuela am23ilas@hotmail.com

Ingrid Rangel Venezuela rangel.ingrid@gmail.com

Neonatologists

Central America and Caribbean

Carlos Roberto Martinez Lopez El Salvador carlosmartinez@navegante.com.su

Marco Rivera Meza Nicaragua dr.marco.rivera@gmail.com

Tania Corpeno Olivas Nicaragua tanieli6@yahoo.com.mx

Nurses

South America

Norma Erpen Argentina nornier@msn.com

Maria Claudia Rearte Argentina mariaclaurearte@hotmail.com

Aida Luz Ramirez Segovia Ramirez Bolivia clinojos@cosett.com.bo

Cristina Tolaba Jurado Bolivia clinojos@cosett.com.bo

Lourdes Tatiana Torres Bolivia clinojos@cosett.com.bo Cecilia Reyes Acuña Chile creyes@minsal.cl

Margareth Dutra Brazil enfemar@ig.com.br

Irama Lopez Venezuela iramaaguilargalarraga@hotmail.com

Central America and Caribbean

Jovita Placencia, Mexico Mexico majovita@todito.com

Facilitators

Augusto Sola USA augustosolaneo@gmail.com

Ana Quiroga Argentina ana.quiroga@rec.austral.edu.ar

Clare Gilbert UK Clare.Gilbert@lshtm.ac.uk

Graham Quinn USA quinn@email.chop.edu

Marco A. de la Fuente Torres Mexico marcodelafuente@hotmail.com

Andrea Zin Brazil andrea_zin@yahoo.com.br

COMMUNITY EYE HEALTH COURSE VISION 2020-THE RIGHT TO SIGHT

Tegucigalpa, Honduras October 08-10, 2008

Course Organized by CBM-CARO I Background information

Honduras is the second poorest country in Central America with a population of 7.6 million. According to the World Fact book it is estimated that 50.7% of the population is living below the poverty line. Honduras is divided in 18 departments: Atlantida, Choluteca, Colon, Comayagua, Copan, Cortes, El Paraiso, Francisco Morazan, Gracias a Dios, Intibuca, Islas de la Bahia, La Paz, Lempira, Ocotepeque, Olancho, Santa Barbara, Valle and Yoro. The main eye health services are provided in the capital Tegucigalpa and the northwestern part of the country. There are about 60 ophthalmologists in the whole country. CBM support for this country in diverse mandate areas is required. Prevention of blindness is certainly one of the key areas to work on. In January 2008, RO staff announced the intention of CBM to organize a Community Eye Health Course in Honduras; dates for the course were agreed according to facilitator’s availability and in agreement with PBL partners and the president of the National Committee of prevention of Blindness. This was the first CEH course carried out in Honduras. It was directed to ophthalmologists, eye nurses, ophthalmic assistants and project managers. Participants came mainly from the capital, Tegucigalpa, and from the second most important city, San Pedro Sula. Both places are where most professionals are concentrated. In Honduras, there is a National Committee for V2020 named “Asociación Nacional de Visión 2020 Honduras” (ASONAVIH). In May 2007 a draft of the National Plan for prevention of blindness was presented to CBM (see document attached) this document was developed mainly with the contribution of Dr. Alvarado and Mr. Bahr. The draft of the plan has also being revised by Dr. Van Lansingh. This plan is not completed at the present time but stakeholders are still working on it. Due to the many replacements of Ministry of health poor progress has been achieved to involve public health authorities. The president of the V2020 committee, Dr. Doris Alvarado, is presently working at the most important reference hospital in Honduras “Hospital General San Felipe” located in the capital city. Moreover, Dr. Alvarado is president of the National Ophthalmology Society. II – Aims and Objectives:

1. Develop strategies to work efficiently within the framework of community eye health programmes.

2. Present the current situation of blindness in Latin America and Caribbean 3. Contribute with activities for prevention of blindness 4. Promotion of a National Plan for Honduras 5. Establish local alliances

II - Faculty members:

1. Dr. Pedro Gomez, Director of Instituto de la Visión, NL, México. CBM Medical Adviser

2. Dr. Felipe Chiriboga, Medical Director of the Fundación Oftalmológica del Valle, Ecuador. CBM Medical adviser

3. Dr. Colin Cook, Opthalmologist, Groote Schuur Hospital VISION 2020 project, Cape Town, South Africa.

II- Programme and list of participants (See attachment) IV- Course

The course took place at Real Clarion Hotel located in Tegucigalpa, Honduras. It was a four days course. During the organization of the course participants were strongly encouraged to attend. Invitation letters to the ministries of health and education were emailed prior to the course. Key stakeholders such as the director of the university resident programme, personnel from the public health and ophthalmologists were invited. However, there was a poor reaction from the local people which highly threat the successful of the course.

Sadly, only 24 persons attended the course out of which 9 were ophthalmologists, the other participants were project managers, the only resident, optometrists, doctors and students willing to start the ophthalmology residence programme. Considering the number of ophthalmologist in the country (60), it indicates that 15% of the ophthalmologist in Honduras attended the CEH course. CBM organized a welcome cocktail during the first evening of the course. Unfortunately, during this day people went on strike against the new Minister of Health, Dr. Carlos Aguilar, and consequently he did not attend. The representative of the education sector confirmed her participation but she never showed up. Facilitators delivered their presentations according to the programme planned. During the days of the course, participants showed their interest on the themes presented by the speakers. Nevertheless, due to the heterogeneous group it was very difficult to coordinate group activities and to present better outcomes. During the fourth and last day, the audience considerably decreased.

V- Achievements

- Facilitators strongly encourage the National Committee members to work toward the development of a suitable National Plan

- Participants started to create alliances between different eye clinics and other stakeholders.

- A representative of the “Healthy Schools Programme” (Programa Escuela Saludables) expressed her will and commitment to coordinate activities with the different eye clinics and the staff of the public hospital San Felipe.

- Awareness of the current situation of blindness in Latin America, Caribbean and their own local situation.

VI- Problems

• Ophthalmologists are not willing to invest their time in Community eye health courses.

• National Plan has being developed theoretically, however the key people has not being involved. Local authorities do not seem to be interested in participate to the National Plan activities. Their estimated figures are not according to the real need.

• On the other hand, an important factor to be considered is the Cuban presence in Honduras (Misión Milagro) and recent political agreements between Venezuela and Honduras.

VII - Future plans per organizations, clinics (Group exercise)

- National Committee on PBL to work on the plan according to their real situation, figures and needs.

San Felipe Hospital

• To improve patients flow • Sensitize ophthalmologists in the community eye health • To plan surgical campaigns • To utilize the operating room during the evening shift.

Refractive error:

• To impulse and create a refractive error programme in coordination with the healthy schools programme personnel (Programa de escuela saludable) concentrating on children of 6th grade.

Centro Oftalmológico Vida Abundante (COVA)

• To open a clinic in the rural area and provide transport to the patients of the surroundings.

• To utilize in the cataract eye surgeries the topic anaesthesia. Refractive error:

• To create alliances with Hospital San Felipe and healthy schools programme to have a suitable refractive error programme. Look also for donation of glasses for the children detected.

Centro Cristiano de servicios Humanitarios de honduras (CCSHH)

• To try to find good community leaders in order to better organize the brigades

• To organize brigades frequently • To implement a “counsellor service” at the clinic

Refractive error:

• Increase funding for glasses Lion’s Club la Fraternidad.

• Establish alliances with community leaders for the community eye health • Training social promoters • Include teachers in a refractive errors programme.

VIII – Recommendations

• To provide stronger support to the National Committee V2020 from IAPB, in order to involve key people and local authorities.

• To establish alliances and team work for the PBL activities. • To promote at university level the ophthalmology residence programme in

order to have more local resources available. Training at different levels is also needed. Advisers strongly recommended promoting the ophthalmology resident programme (to admit more doctors) or to open a new residence programme in SPS, due to the real need of having specialized human resources in the country.

• For the following CEH events, have to better selection of participants, looking for stronger commitment in terms of time and plans.

Fecha: 8/8/2001 Evento:

CEH Course Honduras

Fecha evento: 08-11 October, 2008

Lugar: Tegucigalpa, Honduras

PARTICIPANTES:

Nombre Apellidos Organización

1 Sra Judith de Zelaya COVA

2 Dra. Eyda Calero SUPRECO

3 Lic. James Bahr Club de Leones la Fraternidad

4 Dr. Celeo Ramírez Hospital General San Felipe

5 Dr. Ricardo Javier Toro Pineda Servicio de Oftalmología Hospital General San

Felipe

6 Dr. Sandro Angelo Murcia Hospital General San Felipe

7 Dr. Marco Aurelio Robles Villela

8 Dr. Eduardo Flores Centro Oftalmológico Vida Abundante

9 Dra. Mayra Ochoa Centro Oftalmológico Vida Abundante

10 Dr. Diego Mejia

11 Dr. María del Carmen Sevilla Hernandez

Depto de Atencion Integral a la Persona con Discapacidad / Secretaria de Salud de Honduras

12 Ing. Luis Alonso Prudoth Club de Leones la Fraternidad

13 Dr. Franco Emérito Pacheco Barahona Club de Leones la Fraternidad

14 Marlen Dinora Brevé Sanchéz

Asistente Técnico del Programa Escuelas Saludables, PES asignada al dpto. de Francisco

Morazán

15 Dra. María Teresa López López Secretaria de Salud y PREPACE

16 Dr. Kevin Miller Centro Cristiano de Servicios Humanitarios de

Honduras (CCSHH)

17 Camilo Alberto Bueso Centro Cristiano de Servicios Humanitarios de

Honduras (CCSHH)

18 Carlos Jalil Cabrera Alvarado Centro Cristiano de Servicios Humanitarios de

Honduras (CCSHH)

19 Dra. Doris Alvarado Hospital General San Felipe

20 Dra. Gabriela Guisselle López Chieza Hospital General San Felipe

21 Dra. Luisa Amanda Rojas Club de leones Comayaguela y Hospital San felipe

22 Dra. Belinda Rivera Gómez Hospital General San Felipe

23 Dr. Luis Alberto Lagos COVA, Hospital San Felipe

24 Dra. Elisa Regalado del Corral Oftalmocentro

FACILITADORES/ PONENTES

Nombre Apellidos

1 Dr. Pedro Gómez

2 Dr. Colin Cook

3 Dr. Felipe Chiriboga

Jueves 09 de Octubre del 2008 Thursday, October 9th., 2008

Hora / Time Tema Topics

09:00 09:10 10 minutos Resumen del día anterior Summary of previous day

09:10 09:40 30 minutos

Presentación de los grupos de trabajo del día

anterior sobre proyecto de catarata Groups presentations (cataract Project)

Presentación de proyectos Presentation of Projects supported by CBM

09:40 09:50 10 minutos P.2191 Centro Oftalmológico Vida Abundante P.2191 Centro Oftalmológico Vida Abundante

09:50 10:00 10 minutos P.979 Hospital de Ojos La Fraternidad P.979 Hospital de Ojos La Fraternidad

10:00 10:10 10 minutos

P.1968 Centre Cristiano de Servicios

Humanitarios de Honduras

P.1968 Centre Cristiano de Servicios

Humanitarios de Honduras

10:10 10:30 20 minutos Comentarios Comments

10:30 11:00 30 minutos ¿Cómo podemos aumentar el núm. de cirugías? How can we increase the number of surgeries?

11:00 11:30 30 minutos Refrigerio Coffee Break

11:30 12:15 45 minutos

Salud Ocular Comunitaria: Recurso Humano

para manejar un proyecto con alto volumen

CEH: Human resources to manage a high

volume project

Miércoles, 08 de Octubre del 2008 Wednesday, October 8th., 2008

Hora / Time Duration Tema Topics

09:00 09:10 10 minutos Bienvenida Welcome

09:10 09:20 10 minutos Objetivos y Metodología del curso objectives and methodology of the

09:20 09:40 20 minutos Presentación de los participantes Presentation of participants

09:40 10:30 50 minutos

Ceguera en el mundo y en Latinoamérica:

concepto, magnitud y causas

Global Blindness and Blindness in Latin

American: definitions, magnitude and causes

10:30 11:00 30 minutos

¿Qué esta haciendo la Sociedad Hondureña de

Oftalmología en prevención de Ceguera?

Activities of the Sociedad Hondureña de

Oftalmología

11:00 11:30 30 minutos Refrigerio Coffee Break

11:30 12:00 30 minutos

¿Qué está haciendo el MSP en Prevención de

Ceguera?, políticas y programas. Eye Health Policies and programmes

12:30 13:30 60 minutos Catarata: TCC y control de calidad Cataract: CSR rate and quality control

13:30 15:00 90 minutos Almuerzo-Comida Lunch

15:00 15:30 30 minutos Flujo de pacientes Patients flow

15:30 16:00 30 minutos Costos de cirugía de catarata Costs of Cataract Surgery

16:00 16:30 30 minutos

Asociación Nacional Visión 2020. Actividades y

planes ASONAVIH (vision 2020) Activities and plans

16:30 16:50 20 minutos Refrigerio Coffee Break

16:50 17:20 30 minutos Monitoreo de resultados en cirugías de catarata Monitoring of cataract surgeries

17:20 18:00 40 Minutos Trabajo en Grupo sobre Cataratas Group exercise (cataract)

12:15 13:30 75 minutos

Foro: Tecnología Apropiada: cirugía de catarata

(Faco Vs Sics) Appropriate technology (based on outcomes)

13:30 15:00 90 minutos Almuerzo Lunch

15:00 15:30 30 minutos Barreras en la detección de pacientes con catarata Barriers in detection of patients with cataract

15:30 16:00 30 minutos CBM: Visión 2010 CBM Vision 2010

16:00 16:30 30 minutos Errores Refractivos-Salud Escolar Refractive Errors- School eye health

16:30 16:50 20 minutos Refrigerio Coffee Break

16:50 17:00 10 minutos Comentarios Comments

17:00 18:00 60 minutos

Trabajo en grupo para un programa de salud

visual escolar

Group exercise (Eye health programme in

schools)

Viernes 10 de Octubre del 2008 Friday, October 10th., 2008

Hora / Time Tema Topics

09:00 10:00 1 hora

Ceguera Infantil : Definición, magnitud y causas

Xeroftalmía, catarata, ROP, enfermedades

genéticas y anormalidades congénitas)

Childhood Blindness: definition, magnitude and

causes

10:00 10:30 30 minutos ROP en Honduras ROP in Honduras

10:30 11:00 30 minutos

Cómo se planean los servicios para combatir la

ceguera infantil en el plan V2020

Planning services for V2020 (childhood

blindness)

11:00 11:30 30 minutos Refrigerio Coffee Break

11:30 12:00 30 minutos Baja Visión Low Vision

12:00 12:40 40 minutos Retinopatía Diabética: definición y magnitud Diabetic Retinopathy: definition and magnitude

12:40 13:10 30 minutos Casos de detección Screening for diabetic retinopathy

13:10 13:30 20 minutos Manejo gerencial Management

13:30 15:00 90 minutos Comida Lunch

15:00 15:35 35 minutos Grupo de trabajo en Retinopatía diabética Grooup excercise: Diabetic Retinopathy

15:35 15:50 15 minutos

Cambios en la calidad de vida de los pacientes

operados Changes in quality of life: patients

15:50 16:20 30 minutos

Perfil del trabajador comunitario. Trabajo en el

campo

Job description of Community workers. Work in

the field

16:20 16:40 20 minutos Refrigerio Coffee Break

16:40 17:10 30 minutos Glaucoma: definición y magnitud Glaucoma: definition and magnitude

17:10 17:25 15 minutos Detección temprana de Glaucoma Early detection (glaucoma)

17:25 18:00 35 minutos

Presentación de otros proyectos no apoyados

por CBM Projects presentations others that CBM projects

Sábado 11 de Octubre del 2008 Saturday, October 11th., 2008

Hora / Time Tema Topics

08:00 8:30

30 minutos

Programas de residencia de oftalmología en

Honduras. Curriculum Residence programmes

8:30 9:00 30 minutos Plan Nacional de Prevención de Ceguera: metas National Plan in Prevention of Blindness:

concretas y compromisos. (Trabajo en Grupos) concrete goals and commitments (group

exercises)

09:00 10:00 60 minutos

Presentación de resultados de grupos sobre metas y

compromisos Presentation of group exercises

10:00 10:30 30 minutos

Administración eficiente en programas médicos

sociales Efficient management in social programme

10:30 11:00 30 minutos Refrigerio Coffee Break

11:00 11:30 30 minutos Resumen, conclusiones Summary and Conclusions

11:30 12:00 30 minutos Cómo solicitar apoyo a CBM How to request support from CBM

12:00 12:30 30 minutos Entrega de diplomas y clausura Certificates and closing sessions

Course of Community Eye Health to students of the Residency Program accredited by the

Brazilian Council of Ophthalmology (CBO) for the South – Southeast Regions

Centro de Estudos Moacyr Álvaro, Federal University of São Paulo

São Paulo, Brazil October 20-24, 2008

The course took place in Luis Carlos Reys building, Centro de Estudos Moacyr Álvaro, in São Paulo, São Paulo State - Brazil from October 20-24. The course was organized by Andrea Zin, Celia Nakanami, and the CBO, it was sponsored by CBM, Sightsavers International and ORBIS through the IAPB, City Junior, Latinofarma, Genentech, Óticas Giardini. . Background

In October 2005, 28 participants from 11 residency programs, representing the whole country, attended a meeting in Brasilia to discuss including Community Eye Health in the Brazilian ophthalmology residency program. At the end of that workshop it was suggested that a five day course in Community Eye Health for ophthalmology residents should be developed, and that Celia Nakanami should be trained at the Diploma Course in Community Eye Health at LSHTM in 2006. In November 2006 the second workshop took place in Sao Paulo, where the Brazilian ophthalmologists who were present in that meeting decided who was going to prepare the lectures, and the division of the time table for the course. The meeting also decided to send Roberta Ventura (from Altino Ventura Foundation), to the Diploma Course in Community Eye Health at LSHTM in 2007. Roberta Ventura would be responsible for organizing courses in the North-East region, based in Recife, and Celia Nakanami would take responsibility for courses in the South-East, based in Sao Paulo. In December 2007 another seminar was held in Campinas – Sao Paulo – where the ophthalmologists presented the lectures. Dr Rainald Duerksen was present at this meeting. The dates for the courses were planned - May in Recife and October in Sao Paulo. In May 2008, the first Course of Community Eye Health to students of the Residency Programs accredited by the Brazilian Council of Ophthalmology (CBO) for the North – Northeast Regions was held in Recife. There were represented 70% of residency programs of the region (twenty two residents from 7 residency programs). The experience of residents developing a Project/Program was really good. The working group activity was the most valuable part of the course. Aim and Objectives The student should have knowledge of: the VISION 2020 initiative, steps and tools to be used for an action plan and strategies to develop an eye care project/program based in the VISION 2020 program. Topics covered

• Basic epidemiology and basic statistics • Research methodology/ RACSS/RAAB • Assessing the disease in the community/Resources/Disease Control Strategies/ Monitoring

(cataract, refractive errors, glaucoma, diabetic retinopathy, childhood blindness, trachoma, low vision)

• Leadership/ Management of programmes • Planning V2020 programs

Facilitators Dr Miriam Cano, Asunción, Paraguay Dr. Celia Nakanami, UNIFESP Dr. Marinho Scarpi, UNIFESP Dr. Paulo Henrique Morales, UNIFESP Dr. Norma Medina, São Paulo State Health Secretariat

Dr Silvia Kitadai, UNISA Dr João Marcello Furtado, USP-Ribeirão Preto Dr Carlos Arieta, UNICAMP Dr Andrea Zin, IFF/FIOCRUZ

Invited Speakers Dr Pedro Carricondo, USP

Dr Gelse Beatriz Monteiro, UNICAMP Dr Rosa Graziano, USP

Participants Thirty four residents from 25 residency programs from the South-Southeast regions attended the course. Seventy percent of residency programs accredited by the CBO were represented (Appendix 1). Eighty percent were second year residents.

Programme Prof Paulo Augusto de Arruda Melo, CBO coordinator of the teaching committee and Professor of Federal University of Sao Paulo, gave a warm welcome. The lectures were given as planned in the attached timetable (Appendix 2). Dr Miriam Cano introduced IAPB and V2020 program The “Definition of visual impairment (blindness and low vision)” lecture, using the classification adopted by ICD-10-WHO was included to reinforce basic concepts. After the morning lectures, students were divided into four groups and they were required to perform exercises according to the topic covered during the morning. Leadership and marketing/advocacy concepts were given by Dr Scarpi and Graziano. In the last day they were required to develop a V2020 project/program for a population of 1,000,000 inhabitants which should be presented in the last day. The program should include detailed analysis of the needs, an assessment of existing resources, a simple budget and detailed objectives. The facilitators helped all groups as tutors. The working group activity continued every afternoon for the remainder of the course. All the groups presented their project/program in PowerPoint presentations on the last day, and were questioned in detail about their proposals by both the faculty and other course participants Conclusions

1. A total of 56 residents (48% of the total number of 2nd year residents) attended the 2 courses (Recife and São Paulo) organised in 2008.

2. Standardization of lectures is still a challenge. Lectures improved since the course in Recife. Clinical aspects decreased but still there is a need to increase the emphasis on CEH aspects. Facilitators need to revise presentations to standardize content. Dr Zin will revise them with Dr Medina in December 2008 and will send to facilitators for further comments.

3. Participants were very motivated by group work activities, although in the beginning they felt the exercises were not challenging. Majority of residents were familiar with epidemiology concepts and differences between presenting VA and best-corrected VA.

4. Leadership and marketing concepts were also very well accepted. 5. Project/programs were very comprehensive, with well developed situational analysis.

However very clear during presentations the need to reinforce concepts of aim, objectives and activities. Good development of indicators for monitoring, evaluation strategies developed, some with chronogram and detailed budget

6. Participants feedback: concepts given by the course are useful not only for CEH, but also can be applicable in all areas.

Recommendations

1. To keep the 2 courses for 2009, and possibly plan a 3rd one 2. To develop standardized exercises with CEH basic concepts to assure necessary concepts to

be available 3. To discuss with CBO course funding possibilities to assure sustainability 4. To organize a session during the next Brazilian congress a CEH CBO committee session with

the purpose of discussing projects/programmes being developed 5. To organize CEH allumini during next CBO congresses

Appendix 1 – List of participants

Name Residency programme/State Email

São Paulo

Fabio Marques do Nascimento USP-Ribeirão Preto fmnasc@hotmail.com

Flavio Koji Narazaki USP-Ribeirão Preto flaviokoji@yahoo.com.br

Marliene Oliveira Leme FMJ- Jundiai marliene1@yahoo.com

Silvia Taddei Herculano FMJ Jundiai silherculanofmj@yahoo.com.br

Cintia Tullio Fernades FMJ Jundiai citfernandes@yahoo.com.br

Debora de Oliveira Lomba FAMEMA-Marilia deboralomba@predialnet.com.br

Lusa Reis Silva Unisa - Sao Paulo lusareis@hotmail.com

Rafael de Melo Franco Unisa - Sao Paulo rafmelo@hotmail.com

Ismael Augusto Ostetto Inst. Penido Burnier - Campinas iaostetto@hotmail.com

Mariana Sbrana Alves de Souza UNICAMP marisbrana@yahoo.com.br

Fernando Perches Santa Casa - SP fer_araras@hotmail.com

Adriana Valim Portes Santa Casa - SP drinca88@hotmail.com

Flavia Pelinsari Lana HSPE- SP flavia_pl@yahoo.com.br

Mayana Freitas Lopes HOS - Soracaba mayana35@hotmail.com

Elisa Biesdorf Thiesen HOS - Soracaba elisabt@matrix.com.br

Luis Gustavo Biteli UNIFESP - SP luisbiteli@gmail.com

Aline Silveira Moriyama UNIFESP - SP aline_moriyama@yahoo.com

Frederico Fernandes Loss Unesp - Botucatu fredy3795@yahoo.com.br

Pablo Felipe Rodrigues UMC CEO Pacheco doc.pablo@yahoo.com.br

Lucas Maradei UMC CEO Pacheco lucasmaradei@gmail.com

Minas Gerais

Luis Felipe da Silva Alves Carneiro Santa Casa - BH luisfelipecarneiro@gmail.com

Bruno Oliveira Borges HC-UFMG brunooborges@terra.com.br

Danilo da Costa Sousa UFTM Uberaba MG danilomed@yahoo.com.br

Rio de Janeiro

Roberta Piccin Ferreira Inst. Benjamin Constant - RJ betapiccin@gmail.com

Renato Patuzzo Inst. Benjamin Constant - RJ rpatuzzo@yahoo.com.br

Gustavo Bonfadini UFRJ gustavo.bonfadini@yahoo.com.br

Rafael Correa de Almeida Oculistas Associados -CEPOA - RJ rfaelcorrea@yahoo.com.br

Beatriz Machado Fontes UERJ beatriz_fontes@yahoo.com.br

Parana

Luisa Moreira Hopker UFPR - Curitiba luhopker2@yahoo.com.br

Luciana Augusta Raposo UEL - Londrina luau_med@yahoo.com.br

Santa Catarina

Rosa Maria Tasmo Costa Hospital Regional de Sao Jose/SC mkcosta@uol.com.br

Rio Grande do Sul

Douglas Haeser Weiss Banco de Olhos Porto Alegre doweiss@yahoo.com.br

Almir Sabrosa Santa casa - Porto Alegre assabrosa@gmail.com

Ticiana Granzotto Inst. Ivo Correa Meyer - PA ticianagranzotto@yahoo.com.br Appendix 2 - Timetable DAY 1 8:00- 8:10 Welcome Prof Paulo Augusto Arruda Melo 8:10 – 8:45 Vision 2020 Miriam Cano 8:45 – 10:00 Epidemiology-Basic Concepts Marinho Scarpi 10:15- 10:30 Break 10:30-11:30 Epidemiology of Blindness Miriam Cano 11:30 – 12:30 Statistics Marinho Scarpi 12:30 – 14:00 Lunch 13:30 – 16:00 Research Methodology Andrea Zin 16:00- 16:15 Break 16:15- 18:00 Research Methodology (RAAB,

RACSS) Miriam Cano

Acessing Diseases in the Community Strategy for Control of Diseases Monitoring DAY 2 – Cataract/Refractive Errors 8:00- 10:30 Cataract Arieta/Miriam Cano/Arnaud

Araujo Filho 10:30 – 10:45 Break 10:45- 12:15 Refractive Errors Pedro Carricondo/Denise

Fornazari 12:15- 13:45 Lunch

DAY 3-Glaucoma/Diabetic Retinopathy 08:00 – 9:30 Diabetic Retinopathy Paulo Henrique Morales 9:30-9:45 Break 9:45:11:15 Glaucoma Miriam Cano/Carlos Arieta 11:15-11:30 Break 11:30 – 12:30 Resources available: SUS NGOs

Resource mobilization Paulo Henrique Morales Silvia Kitadai Miriam Cano

12:30 – 14:00 Lunch 14:00 – 15:00 Leadership

Human Resources 1 Marinho Scarpi

15:00-16:00 Group Work * 16:00 – 16:15 Break 16:15- 18:00 Group Work presentation ** DAY 4 Childhood Blindness/Trachoma/Low Vision 8:00- 8:45 Childhood Blindness Silvia Kitadai/Denise Fornazari 8:45 – 9:30 Trachoma Norma Medina 9:30- 10:15 Low Vision Keila Miriam/Celia Nakanami 10:15-10:30 Break 10:30-12:00 Leadership

Human Resources 2 Marinho Scarpi

12:00-13:30 Lunch 14:00-15:00 Group Work * 15:00-15:15 Break 15:15 – 17:15 Group Work presentation ** DAY 5 Plan your project!!!!

14:00 – 15:30 Group Work * 15:30-15:50 Break 15:50 – 17:30 Group Work presentation **

08:00 – 09:45 How to plan ( HERE- THERE) Miriam Cano 09:45- 10:00 Break 10:00-12:30 Group work 12:30 – 14:00 Lunch 14:00 – 15:30 Group work 15:30- 17:00 Group work presentations 17:00 Closing and certificates

REPORT ON THE THIRD COURSE IN COMMUNITY EYE HEALTH

MANAGEMENT

Asuncion, Paraguay, Oct 30th – Nov 7

th 2008

An event organized by Fundación Visión and the International Agency for the Prevention of

Blindness (IAPB) Latin America.

1. Introduction: This is the third course of this type offered in our region, and it received generous financing from the regional CBM offices, the International Centre for Eye Health

(ICEH), IAPB Latin America, and Alcon Laboratories. Locally, SER Group International,

Ciba Vision-Comfar, DGR Internacional, and La Santaniana Bus Company supported the

course with several items and transportation. The organization was planned and executed

by Nydia Silva, BA, Cristina Caballero, BA and Dr. Fernando Pena, with the support of

Dr. Van Lansingh from VISION 2020 Latin America. The course was taught by a

recognized group of experienced faculty. The teaching methods consisted of lectures,

group work, structured assignments, and self-learning. At the end of the course,

participants had the opportunity to witness successful fieldwork in a community that

regularly holds eye surgical campaigns.

2. Background: The international course in CEH management is widely known among

various institutions in Latin America and has been a core element for the appropriate

development of projects in the prevention of blindness, according to the reports from some

of the participants to previous courses.

3. Setting and Program: This year, 21 participants joined the course from diverse Latin

American countries such as Mexico, Nicaragua, El Salvador, Puerto Rico, Peru, Colombia,

Bolivia, Chile, Brazil, Argentina, and Paraguay.

One of the major innovations of this course was the establishment of three module sections

according to the composition of project cycles in management: Module 1, project design

and marketing; Module 2, finances and accounting; and Module 3, human resources and

ethics. This design allowed the participants to obtain broad spectrum understanding that a

health care provider and manager needs in order to develop a sustainable project. The

course was targeted at administrators of community eye health projects, who are expected

to play an important role in the future, for the purpose of providing them with the tools to

achieve sustainability and the means with which to perform planning of services within the

framework of the recommendations for development of a national eye health plan.

Module 1: PLANNING AND MARKETING

Aim: Learn how to begin a project.

Participants were able to generate ideas on how to create a project, and received practical

tools for the planning and carrying out of eye health initiatives based on their actual reality

and resources. This enabled participants to make decisions and design strategic planning.

Lectures and workshops for this Module: Epidemiology, global blindness: cost and

ocular assistance, community eye health, Vision 2020 global and Latin America,

advocacy, benchmarking, strategic planning on community eye health project, marketing,

and networking to pursue a sustainable blindness prevention program, and surgical

campaigns

Module 2: ADMINISTRATION AND FINANCE

Aim: learn how to finance and administrate a project.

Participants were provided with practical tools to measure financial feasibility of the

project, generate the necessary administrative processes in order to implement the project,

and tools for monitoring and evaluation.

Lectures and workshops for this Module: Sustainability of the project, basic finances,

cost and available tools, project cycle management, quality management and control,

fundraising, the Aravind experience, and how to purchase and maintain equipment.

Module 3: HUMAN RESOURCES

Aim: Learn how to manage human resources.

Participants were provided with effective tools to achieve better human resources

management, including selection, recruitment, organization, and evaluation, as well as

tools for better rapport with colleagues and employers, and personal growth.

Lectures and workshops for this Module: Ethics in health management, leadership and

teamwork, time management, motivation, successful communication, human resources

management, and performance evaluation.

4. The course was intended for: Physicians, ophthalmologists, nurses, administrative

personnel, and managers of eye-health programs.

5. Objectives: To train participants, so that upon completing the course they are able to:

a. Prepare a project according to the guidelines of a VISION 2020 district plan and

participate with the committees of their respective countries in the formulation of a

national eye health plan in order to fulfill the objectives set forth in the May 2003

resolution of the World Health Assembly, and to use the resolution of May 2006 for

advocacy activities within their respective governments in relation to the assignment of

resources to this priority area.

b. Utilize administrative, accounting, and marketing techniques to improve programs or

generate new ones, evaluate progress, and apply corrective measures.

c. Offer presentations on priority pathologies supported by the didactic materials provided,

organize advocacy meetings, and attempt to introduce CEH to training programs.

d. Maintain a network of contacts in various countries for mutual assistance and support for

preparation of activities to be carried out.

Program, Participants, Faculty and Organizing Committee: (See Annexes 1 and 2)

Results Related to Objectives

(1) All participants were given the information needed to prepare a project according to the

VISION 2020 district plan and participate with the committees of their respective countries in

the formulation of a National Eye Health Plan in accord with the objectives set forth in May

2003 resolution of the World Health Organization (WHO). They were also shown the

methods by which they can perform advocacy with their governments and other government

entities and comply with the WHO resolution of May 2006.

Various exercises were carried out after the lectures to critically analyze the existing situation

in each of the major causes of blindness and the projects needed to create or improve the eye

health care in the region, with special emphasis in community work. The sessions were

dynamic, and we consider that the participants will be able to influence their respective

communities and local governments for the development or improvement of existing projects.

(2) The participants were also provided with the administrative, accounting, and marketing

techniques needed to improve programs, evaluate progress, and apply corrective measures.

These sessions generated a great deal of interest, and with the assistance of the speakers and

organizers, as well as some participants with knowledge in the field, many ideas were

generated related to sustainability, increased coverage, and quality of service.

(3) With the support of the didactic materials provided, they will be able to offer

presentations on priority diseases, organize advocacy meetings, and introduce CEH into

training programs.

All the participants received electronic and printed copies of the educational materials in both

English and Spanish, as well as various references available on the Internet, to be used in

their respective institutions and other forums within their countries.

(4) They were also given information about all the participants and organizations involved so

that they could create a network of contacts in the various countries that could provide them

with pertinent advice, and support and assistance in developing selected projects.

Other Results:

(1) Fundación Visión reinforced the alliance with the Universidad del Pacífico, also of Paraguay, to permit the issuance of certificates of participation worth academic credit,

something made possible by the fact that the university is listed with the WHO world

directory of medical schools and the Foundation for the Advancement of International

Medical Education and Research (FAIMER).

(2) The teachings shared by some speakers about their experience with other successful

projects in prevention of blindness and with excellent management were of great

importance to demonstrate what can be accomplished in the eye-care field with the

proper management of human, equipment, and economic resources.

(3) The event met with very little success financially, in particular due to the devaluation

of the dollar, which resulted in no income for the organization.

(4) Just as in the previous year, the opening of the course was very interesting, thanks to the participation of Dr. Serge Resnikoff of the WHO and Dr. Dipankar Datta of

Aravind in India, whose presentations were impeccable and dynamic.

Lessons Learned:

(1) This year, organization of the course was prepared and held by experienced personnel in Paraguay, who coordinated the logistic and academic aspects of the course. All the

contact function was left to the IAPB LA Office.

(2) It was observed that forming groups of persons who are Spanish-speaking is a useful

strategy to help avoid the expenses and problems arising from the need for

interpretation and translation. This was particularly important because all the

participants from Brazil understood and were able to communicate in Spanish.

(3) Once again there were difficulties with securing a visa for our guest from India.

Although we began the process early, there was a last moment impasse due to the fact

that the programmed speaker became ill the week prior to the event. However with a

phone call to the Paraguayan embassy in India, the situation was resolved.

(4) One speaker (Carlos Coscia) could not reach to Paraguay due to personal matters. His

conference was covered by local speakers.

(5) We realized that one day is enough time for the participants to spend on the surgical

campaign, especially because the aim of the course is oriented more to management

and administration of community eye health projects than to the basic conduct of

surgical brigades. We suggest that for the future events, presenting a video about the

organization of a surgical campaign in Paraguay should be considered.

(6) This time the course had a duration of 9 days, and we consider that it was appropriate

and should not be longer than 10 days for future courses.

(7) The curriculum and presenters should be confirmed by the end of April for the next

course so as to avoid logistical problems.

(8) The course should be promoted by various means from the beginning of 2009.

(9) The logistical aspects of lodging, tourism, and travel should remain the responsibility

of trusted travel agents, as was done this time.

Evaluation and Suggestions from Course Participants:

ASSESSMENT OF THE THIRD COURSE ON MANAGEMENT OF COMMUNITY

EYE HEALTH, OCT. 30 – NOV. 7, 2008

Results of the survey done with both multiple choice and open questions:

Of the 21 participants, 20 responded that the knowledge acquired in the course would be

useful to them, and all 21 said that the course provided all the tools needed to manage their

projects in the future.

The pathologies on which they most wished to work for prevention of blindness are cataract,

refractive error, ROP, and diabetic retinopathy. Only 4 participants mentioned glaucoma.

They liked and had a positive impression of all the conferences, but those most frequently

mentioned were those by Aravind (Dr. Datta), Colin Cook, motivation, ethics, advocacy,

fundraising, and time management.

In general, they said that none of the conferences failed to make a good impression, but

repeatedly said that those on equipment maintenance were the least impressive or least useful.

Five (5) participants said that the conferences in English were of little use, but the remaining

16 said they were very useful.

All were very satisfied by the services of the hotel and the travel agency except for one

person whose name had been gotten wrong, and one other who said that there had been little

variety in the food. Some mentioned that they would have liked more time for shopping.

All were satisfied with the logistical organization, the simultaneous interpretation, and the

organization of the conferences.

All said they would recommend the course to colleagues and friends.

The primary suggestions made for the future were:

1. To provide a guide text or reference work

2. To have more practical examples during the conference, with more workshop

activities.

3. To consider having the course in another country due to the difficulty most had in

traveling to Paraguay.

4. To do follow up of former students and show the results of other projects.

5. To keep up contacts among all involved.

All the participants were generally happy with the organization of the course, including the

academic content, lodging, facilities, the schedule, and the logistical set up for the various

events at the hotel and elsewhere.

I personally heard no complaint from any of the participants except for that of being tired by

the end of it, and all participants agreed that the course should not be made longer than this

year’s.

It must be remembered that this is not a workshop on community eye health itself, and so

participants do not expect much training on blindness prevention programs or eye diseases,

since most, not to say all, are in any case ophthalmologists and have participated in various

workshops on prevention of blindness and community eye health in their respective

countries.

It would therefore be useful in the future to make a clear distinction between those courses

more oriented toward prevention of blindness and carrying out specific programs for

individual eye diseases, and those with more management oriented content, such as those we

offered on this occasion.

Finally, the organization of the course in modules allowed both improved organization of the

conferences and workshops and better understanding and learning by the participants.

PROGRAMA ACADEMICO

MODULO DISERTANTE

8:00 - 9:00 Duerksen / Lansingh / Cibils / Peña

9:00 - 10:00 V. Lansingh

10:00 -10:30

10.30 -11:00 1 S. Resnikoff

11:00 - 12:00 1 S. Resnikoff

12:00 - 13:00

13:00 - 14:00 1 D. Datta

14:00 - 15:00 1 D. Datta

15:00 - 15:30

15:30 - 16:30 1 R. Brown

16:30 - 17:30 2 F. Yee

17:30 - 18:30 2 D. Datta

CAFÉ

Marketing

Marketing

ACTIVIDAD

Jueves 30 de Octubre

Vision 2020

Aspectos de la salud mundial

Inauguracion y presentacion de participantes

III CURSO INTERNACIONAL DE GERENCIAMIENTO

EN SALUD OCULAR COMUNITARIA

30 octubre al 7 de Noviembre

Asunción, Paraguay

CAFÉ

Ceguera, Costos y Asistencia Social

ALMUERZO

Calidad de servicios - (software de Guatemala)

Calidad en Salud Ocular Comunitaria

Alianzas estrategicas

8:00 - 9:00 1 F. Peña

9:00 - 10:00 1 Datta/Yee/Duerksen/Contreras

10:00 - 10:30

10:30 - 11:30 1 Datta/Yee/Duerksen/Contreras

11:30 - 12:30 1 Datta/Yee/Duerksen/Contreras

12:30 - 13:30

13:30 - 14:30 2 Colin Cook

14:30 - 15:30 2 Colin Cook

15:30 - 16:00

16:00 - 17:00 2 D. Datta

17:00 - 18:00 1 D. Datta / F. Yee

Benchmarking - mesa redonda

Gerenciamiento de proyectos en SOC

Analisis de costos en un proyecto de SOC

CAFÉ

Viernes 31 de Octubre

Benchmarking - mesa redonda

Atencion Primaria en Salud - Atencion Ocular Primaria

ALMUERZO

Sustentabilidad de un proyecto

Benchmarking - mesa redonda

Planeacion de servicios a nivel Distrital

CAFÉ

8:00 - 9:00 1 F. Peña

9:00 - 10:00 1 F. Barria

10:00 - 10:30

10:30 - 11:30 2 F. Yee

11:30 - 12:30 2 D. Ciccone / O. Benitez

12:30 - 13:30 2 D. Ciccone / O. Benitez

13:30 - 14:30

Sabado 01 de Noviembre

ALMUERZO

Finanzas para no financieros

Epidemiologia en Prevencion de la ceguera

Cabildeo en el desarrollo de proyectos de SOC

CAFÉ

Finanzas en un proyecto de Salud Ocular Comunitaria

Finanzas para no financieros

ANNEX 1: PROGRAM AND FACULTY

8:00 - 9:00 1 César González (CBM)

9:00 - 10:00 1 César González (CBM)

10:00 - 10:30

10:30 - 11:30 1 César González (CBM)

11:30 - 12:30 1 César González (CBM)

12:30 - 13:30

13:30 - 14:30 1 César González (CBM)

14:30 - 15:30 1 César González (CBM)

15:30 - 16:00

16:00 - 17:00 1 César González (CBM)

17:00 - 18:00 3 C. Coscia

Ciclo de Gerenciamiento de un Proyecto

Lunes 03 de Noviembre

Ciclo de Gerenciamiento de un Proyecto

CAFÉ

CAFÉ

Ciclo de Gerenciamiento de un Proyecto

Ciclo de Gerenciamiento de un Proyecto

ALMUERZO

Ciclo de Gerenciamiento de un Proyecto

Ciclo de Gerenciamiento de un Proyecto

Responsabilidad Social en oftalmologia

Ciclo de Gerenciamiento de un Proyecto

8:00 - 9:00 2 F. Frydman

9:00 - 10:00 2 F. Frydman

10:00 - 10:30

10:30 - 11:30 2 F. Frydman

11:30 - 12:30 2 F. Frydman

12:30 - 13:30

13:30 - 14:30 1 R. Duerksen

14:30 - 15:30 1 P. Cibils

15:30 - 16:00

16:00 - 17:00 1 M. Cano

17:00 - 18:00 1 M. Cano

Consecusion de fondos

CAFÉ

Programa de PBL en catarata y glaucoma

Programa de PBL en retinopatia diabetica

Consecusion de fondos

Consecusion de fondos

Consecusion de fondos

Martes 04 de Noviembre

ALMUERZO

CAFÉ

Programa de PBL en ROP

Salud Ocular Comunitaria y ONGs en la region

8:00 - 9:00 Dpto. Administrativo

9:00 - 10:00 Dpto. Administrativo

10:00 - 10:30

10:30 - 11:30 Dpto. Administrativo

11:30 - 12:30 Dpto. Administrativo

12:30 - 13:30

13:30 - 14:30 1 V. Lansingh, F. Pena, R. Duerksen

14:30 - 15:30 1 V. Lansingh, , M. Cano, F. Pena

15:30 - 16:00

16:00 - 17:00 2 H. Marais

17:00 - 18:00 2 D. Guggliotta

Visita a la Fundacion Vision

CAFÉ

Miercoles 05 de Noviembre

ALMUERZO

Visita a la Fundacion Vision - INGAVI

Taller SOC (datos de cada pais)

CAFÉ

Visita a la Fundacion Vision - INGAVI

Mantenimiento, compras y gestion de equipos

Visita a la Fundacion Vision

Taller SOC (datos de cada pais)

Costos, herramientas disponibles

8:00 - 9:00 3 F. Peña

9:00 - 10:00 3 J. Mendoza

10:00 - 10:30

10:30 - 11:30 3 N. Silva

11:30 - 12:30 3 N. Silva

12:30 - 13:30

13:30 - 14:30 3 D. Ciccone

14:30 - 15:30 3 D. Ciccone

15:30 - 16:00

16:00 - 17:00 3 M. Vergara

17:00 - 18:00 1 E. Nuñez

CAFÉ

Jueves 06 de Noviembre

Administracion del Tiempo

Administracion del Tiempo - Taller

ALMUERZO

Etica en salud

Organizacion de una camapaña Qx en Paraguay

Evaluacion de desempeño

Seleccion y contratacion de RH

CAFÉ

Motivacion y trabajo en equipo

Motivacion y trabajo en equipo - Taller

05:00 Clínica Belén - Coronel Oviedo

7:00- 8:00

08:30

9:00 - 10:00

10:00 - 11:00

11:00 - 11:30

11:30 - 13:00

13:00 - 14:00

14:00 - 16:00

Cirugia

ALMUERZO

CAFÉ

Viernes 07 de Noviembre

Salida a Coronel Oviedo - CAMPAÑA QUIRURGICA

Desayuno Km 84

Regreso

Llegada Coronel Oviedo Clínica Belén

Area de Consulta

Area Administrativa y Financiera

1 Módulo 1: Proyectos y Mercadeo

2 Módulo 2: Finanzas y Administración

3 Módulo 3: Recursos Humanos

ORGANIZING COMMITTEE

Cristina Caballero Fundacion Vision Paraguay managementcourse@gmail.com

Fernando Pena Fundacion Vision Colombia ojosalud@yahoo.com

Nydia Silva Fundacion Vision Colombia nydiasilva2005@yahoo.com

Van C. Lansingh IAPB Vision 2020 Argentina vlansingh@v2020la.org

PARTICIPANTS

Sergio Velez, Dr Clinica Oftalmologica de Sucre Colombia savo484@hotmail.com

Gonzalo Jaramillo, Dr Proyecto independiente Colombia gonzaloj@une.net.co

Germano Leitao de Andrade, Dr Concilio Brasilero de Oft Brasil germanoandrade@hotmail.com

Otavio Siqueira Bisneto, Dr Concilio Brasilero de Oft Brasil otaviobisneto@hotmail.com

Gustavo Henrique Araujo Salomao, Dr Concilio Brasilero de Oft Brasil salomaooftalmo@yahoo.com.br

Maria Isabel Lynch Gaete Concilio Brasilero de Oft Brasil malynch@nlink.com.br

Fernando Gómez, Dr Pdte Soc Colombiana de Oft Colombia hfgomezgo@gmail.com

Gustavo Rodriguez, Adm. Adm y Asesor Medico Bolivia gusi76@hotmail.com

Amelia Salvatierra, Dra. Salubrista, oftalmologa Nicaragua ameliasalva@hotmail.com

Sirley Vidal, Dra Centro de Salud Ntra Sra Pompeya Beni, Bolivia sirley_vidal@yahoo.com

Manuel Perez Martinot, Dr Instituto de Ojos Sacro Cuore Lima, Perú mperezmart@iosacrocuore.com

Mauricio Perez Martinot, Adm Instituto de Ojos Sacro Cuore Lima, Perú mperezmart@iosacrocuore.com

Nelson Rivera, Adm International Center of Eye Educ EUA n.rivera@icee.org

Napoleón Candray, Dr Clinica Candray El Salvador ncandray@telesal.net

Edwin Arias, Dr Clinica Candray El Salvador edwin.arias@yahoo.com

Erika Oyola, Dra. Residencia Oftalmologica Nano Argentina erikaoyola@hotmail.com

Luis Emanuel Rodrigo, Dr La Rioja Argentina facu_ro@hotmail.com

Armando Munoz, Dr Leones Mexico Mexico drarmandomunoz@hotmail.com

Victoria Moya, Enfermera Instituto Regional de Oft de Trujillo Trujillo, Peru freya_023@hotmail.com

Jeisson Castro, Dr Residencia Oft. Fundacion Vision Paraguay jeisson555@hotmail.com

Patricia Lopez, Dra Residencia Oft. Fundacion Vision Paraguay mabelti@hotmail.com

SPEAKERS

Cesar Gonzalez CBM Peru cjdgt@hotmail.com

Fernando Pena Fundacion Vision Colombia ojosalud@yahoo.com

Nydia Silva Fundacion Vision Colombia nydiasilva2005@yahoo.com

Van C. Lansingh IAPB Vision 2020 Argentina vlansingh@v2020la.org

Fernando Barria Vision 2020 America Latina Chile fdobarria@vtr.net

Daniel Ciccone SER Group Internacional Paraguay dciccone@sergroupint.com

Jazmin Mendoza Jazmin Mendoza Consultora Paraguay jm@jm.com.py

Colin Cook CBM / Univ de Capetown Sudafrica colin.cook@uct.ac.za

Serge Resnikoff OMS Ginebra Suiza resnikoffs@who.int

Rainald Duerksen Fundacion Vision Paraguay rd@conexion.com.py

Raymond Brown Vision Paraguay Reino Unido raymond.brown12@btopenworld.com

Francisco Yee Visualiza Guatemala Guatema juan.yee@visualiza.org.gt

Francisco Contreras APO Peru fcontreras@oftalmologoscontreras.com

Dukantar Datta Aranvind India datta@aravind.org

Pablo Cibils Fundacion Vision Paraguay pablocibils@fundacion-vision.org.py

Miriam Cano Sociedad Pya de Oftalmologia Paraguay miriam.cano@gmail.com

Daniel Gugliotta DG Internacional Paraguay dgr@tigo.com.py

Hendrik Marais Fundacion Vision Paraguay hendrikmarais@fundacion-vision.org.py

Edgar Nunez Fundacion Vision Paraguay edgar_nunezbordon@hotmail.com

APPENDIX 2: CONTACT INFORMATION AND HOME

COUNTRY OF PARTICIPANTS, SPEAKERS, AND THE

ORGANIZING COMMITTEE